Basic Information
| Provider Information | |||||||||
| NPI: | 1124061130 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BRADEN PARTNERS LP | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PACIFIC PULMONARY SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8730 HARRIS RD UNIT 204 | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933118990 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613963720 | ||||||||
| FaxNumber: | 6618326009 | ||||||||
| Practice Location | |||||||||
| Address1: | 1045 GARDEN OF THE GODS RD STE L | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809073436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7194759955 | ||||||||
| FaxNumber: | 7194759966 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | PARNES | ||||||||
| AuthorizedOfficialFirstName: | YEHOSHUA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 4158931518 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BX2000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies |
ID Information
| ID | Type | State | Issuer | Description | 45058334 | 05 | CO | MEDICAID |