Healthcare Provider Details

I. General information

NPI: 1891733200
Provider Name (Legal Business Name): P B R INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 08/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 18TH ST SUITE B
SPIRIT LAKE IA
51360-1150
US

IV. Provider business mailing address

PO BOX 28
HARTLEY IA
51346-0028
US

V. Phone/Fax

Practice location:
  • Phone: 712-336-1052
  • Fax: 712-336-1057
Mailing address:
  • Phone: 712-728-2165
  • Fax: 712-728-2805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: WALLY J TSCHOPP
Title or Position: OWNER
Credential: RPH
Phone: 712-728-2165