Basic Information
| Provider Information | |||||||||
| NPI: | 1427081876 | ||||||||
| 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. | ||||||||
| Address2: | UNIT 204 | ||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933118990 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613963720 | ||||||||
| FaxNumber: | 6618326009 | ||||||||
| Practice Location | |||||||||
| Address1: | 7850 S HARDY DR | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852841122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804773085 | ||||||||
| FaxNumber: | 4804773089 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 08/26/2013 | ||||||||
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| AuthorizedOfficialLastName: | THOMAS | ||||||||
| AuthorizedOfficialFirstName: | JANE | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 4158931518 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BX2000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies | 3336M0002X | Y | Suppliers | Pharmacy | Mail Order Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 991655 | 05 | AZ | MEDICAID | 200363380C | 05 | KS | MEDICAID | 807577400 | 05 | ID | MEDICAID | 933457000 | 05 | MN | MEDICAID | 03525376 | 05 | NM | MEDICAID | 247370 | 05 | OR | MEDICAID | 100510346 | 05 | NV | MEDICAID | 102200433-0003 | 05 | PA | MEDICAID | 1427081876 | 05 | UT | MEDICAID | XPH015089 | 05 | CA | MEDICAID | 200073720E | 05 | OK | MEDICAID | 200835660A | 05 | IN | MEDICAID | 410773 | 05 | AZ | MEDICAID | 6029029 | 05 | WA | MEDICAID | 200073720D | 05 | OK | MEDICAID |