1295758688 NPI number — BRADEN PARTNERS LP

Table of content: (NPI 1295758688)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295758688 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
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:
1295758688
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 W GERMANTOWN PIKE STE 250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLYMOUTH MEETING
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19462-1437
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-665-6040
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4562 WESTINGHOUSE ST STE F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VENTURA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93003-5797
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
747-224-8338
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RUSSALESI
Authorized Official First Name:
WENDY
Authorized Official Middle Name:
Authorized Official Title or Position:
CCO
Authorized Official Telephone Number:
484-246-9499

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336M0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 240373 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6023428 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200363380B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: PHA455660 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 410856 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 122587100 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 12881228 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200835660B , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9062142 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6031686 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9058660 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 066344 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 807416100 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200073720C , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 210515 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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