1275565350 NPI number — BRADEN PARTNERS, LP

Table of Contents

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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