1275565350 NPI number — BRADEN PARTNERS, LP

Table of content: (NPI 1275565350)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275565350 NPI number — BRADEN PARTNERS, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRADEN PARTNERS, LP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PACIFIC PULMONARY SERVICES/MED-MART
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275565350
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4300 STINE RD
Provider Second Line Business Mailing Address:
SUITE 800
Provider Business Mailing Address City Name:
BAKERSFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93313-2308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-396-3720
Provider Business Mailing Address Fax Number:
661-832-6010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4520 N BANK ST
Provider Second Line Business Practice Location Address:
STE A & B
Provider Business Practice Location Address City Name:
KINGMAN
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86409-2081
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-757-5677
Provider Business Practice Location Address Fax Number:
928-757-5805
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CORDOZA
Authorized Official First Name:
YVONNE
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
VP - FIELD SERVICES
Authorized Official Telephone Number:
415-893-1518

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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