Provider Demographics
NPI:1366161945
Name:BRE MEDICAL PROVIDERS
Entity type:Organization
Organization Name:BRE MEDICAL PROVIDERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:I
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:573-200-8030
Mailing Address - Street 1:405 CENTER ST.
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:MO
Mailing Address - Zip Code:63624
Mailing Address - Country:US
Mailing Address - Phone:573-200-8030
Mailing Address - Fax:573-200-8033
Practice Address - Street 1:405 CENTER ST.
Practice Address - Street 2:SUITE 1
Practice Address - City:BISMARCK
Practice Address - State:MO
Practice Address - Zip Code:63624
Practice Address - Country:US
Practice Address - Phone:573-854-2273
Practice Address - Fax:573-200-8033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-25
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility