Basic Information
| Provider Information | |||||||||
| NPI: | 1912011016 | ||||||||
| 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: | 12284 INDUSTRIAL BLVD | ||||||||
| Address2: | STE 6B | ||||||||
| City: | VICTORVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923955830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7602419364 | ||||||||
| FaxNumber: | 7602419712 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2006 | ||||||||
| LastUpdateDate: | 09/10/2015 | ||||||||
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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 | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies |
ID Information
| ID | Type | State | Issuer | Description | DME03205F | 05 | CA | MEDICAID |