1073549374 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 1073549374 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:
Provider Other Organization Name Type Code:
6
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:
1073549374
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/12/2008
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:
STE 800
Provider Business Mailing Address City Name:
BAKERSFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93313-2354
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:
486 E ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COOS BAY
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97420-4340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-756-7172
Provider Business Practice Location Address Fax Number:
541-756-2991
Provider Enumeration Date:
06/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CORDOZA
Authorized Official First Name:
YVONNE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
SVP CUSTOMER CARE
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)

  • Identifier: 182917 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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