Healthcare Provider Details

I. General information

NPI: 1568551786
Provider Name (Legal Business Name): B. P. & W., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 03/13/2020
Certification Date: 03/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W DAUGHERTY ST
WEBB CITY MO
64870-1924
US

IV. Provider business mailing address

101 W DAUGHERTY ST
WEBB CITY MO
64870-1924
US

V. Phone/Fax

Practice location:
  • Phone: 417-673-4663
  • Fax: 417-673-8673
Mailing address:
  • Phone: 417-673-4663
  • Fax: 417-673-8673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number004952
License Number StateMO

VIII. Authorized Official

Name: KOBY PRATER
Title or Position: PRESIDENT
Credential:
Phone: 417-673-4663