=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174637235
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRADEN PARTNERS LP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2006
-----------------------------------------------------
Last Update Date | 04/25/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18905 33RD AVE W STE 112
-----------------------------------------------------
City | LYNNWOOD
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98036-4715
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-409-8741
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 220 W GERMANTOWN PIKE STE 250
-----------------------------------------------------
City | PLYMOUTH MEETING
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19462-1437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-409-8741
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | STEPHEN GRIGGS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 407-206-0040
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BX2000X
-----------------------------------------------------
Taxonomy Name | Oxygen Equipment & Supplies (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------