Provider Demographics
NPI:1255379244
Name:P B R INC
Entity type:Organization
Organization Name:P B R INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WALLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:TSCHOPP
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:712-728-2165
Mailing Address - Street 1:PO BOX 28
Mailing Address - Street 2:
Mailing Address - City:HARTLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51346-0028
Mailing Address - Country:US
Mailing Address - Phone:712-728-2165
Mailing Address - Fax:712-728-2805
Practice Address - Street 1:141 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:HARTLEY
Practice Address - State:IA
Practice Address - Zip Code:51346-1412
Practice Address - Country:US
Practice Address - Phone:712-928-3300
Practice Address - Fax:712-928-3400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0264184Medicaid