=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013031178
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRAIRIE VIEW INDUSTRIES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2620 INDUSTRIAL DRIVE
-----------------------------------------------------
City | FAIRBURY
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68352-0575
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-729-4055
-----------------------------------------------------
Fax | 402-729-4058
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 575 2620 INDUSTRIAL DRIVE
-----------------------------------------------------
City | FAIRBURY
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68352-0575
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-729-4055
-----------------------------------------------------
Fax | 402-729-4058
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | STOCKHOLDER
-----------------------------------------------------
Name | MRS. KATHLEEN WALDREP
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 402-729-4055
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------