Provider Demographics
NPI:1457406969
Name:WRB ENTERPRISES INC.
Entity type:Organization
Organization Name:WRB ENTERPRISES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-247-7300
Mailing Address - Street 1:PO BOX 986
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-0040
Mailing Address - Country:US
Mailing Address - Phone:270-247-7300
Mailing Address - Fax:270-247-6945
Practice Address - Street 1:715 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-2425
Practice Address - Country:US
Practice Address - Phone:270-247-7300
Practice Address - Fax:270-247-6945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP01629332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90040429Medicaid
KY0399330001Medicare ID - Type Unspecified
KY90040429Medicaid