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General NPI Number Information
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NPI Number | 1366161945
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Entity Type | Organization
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Legal Business Name | BRE MEDICAL PROVIDERS LLC
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Dates
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Enumeration Date | 08/25/2022
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 405 CENTER ST. SUITE 1
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City | BISMARCK
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State | MO
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Zip | 63624
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Country | US
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Telephone | 573-854-2273
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Fax | 573-200-8033
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Provider Business Mailing Address
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Address Line | 405 CENTER ST.
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City | BISMARCK
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State | MO
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Zip | 63624
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Country | US
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Telephone | 573-200-8030
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Fax | 573-200-8033
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Authorized Official
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Title or Position | FNP/CEO
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Name | KIMBERLY IRENE WEISS
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Credential |
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Telephone | 573-200-8030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0050X
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Taxonomy Name | Non-Surgical Family Planning Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 261QC1800X
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Taxonomy Name | Corporate Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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