Provider Demographics
NPI:1073750956
Name:BRAATEN HEALTH LLC
Entity Type:Organization
Organization Name:BRAATEN HEALTH LLC
Other - Org Name:MIDWEST THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTS RECEIVABLE
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:D
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-327-0133
Mailing Address - Street 1:2035 BRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-2478
Mailing Address - Country:US
Mailing Address - Phone:563-326-1400
Mailing Address - Fax:563-326-0700
Practice Address - Street 1:5403 VICTORIA AVE
Practice Address - Street 2:SUITE 20
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3925
Practice Address - Country:US
Practice Address - Phone:563-327-0132
Practice Address - Fax:563-359-5642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
38860OtherWELLMARK BLUE CROSS BLUE SHIELD
IA0645085Medicaid
38860OtherWELLMARK BLUE CROSS BLUE SHIELD