MEDICARE: BRAATEN HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	38860	OTHER		WELLMARK BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073750956
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAATEN HEALTH LLC

Provider Business Mailing Address
First Line	:	2035 BRIDGE AVE
Second Line	:
City	:	DAVENPORT
State	:	IA
Zip	:	52803-2478
Country	:	US
Telephone Number	:	563-326-1400
Fax Number	:	563-326-0700

Provider Business Practice Location Address
First Line	:	5403 VICTORIA AVE
Second Line	:	SUITE 20
City	:	DAVENPORT
State	:	IA
Zip	:	52807-3925
Country	:	US
Telephone Number	:	563-327-0132
Fax Number	:	563-359-5642

Authorized Official
Title or Position	:	ACCOUNTS RECEIVABLE
Name	:	MRS. ANNETTE D LANE
Credential	:
Telephone Number	:	563-327-0133

Provider Enumeration Date	:	01/14/2009
Last Update Date	:	01/14/2009

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Directions to “BRAATEN HEALTH LLC ” Practice Location

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