Provider Demographics
NPI:1568899649
Name:BRAATEN HEALTH OUTPATIENT SERVICES
Entity Type:Organization
Organization Name:BRAATEN HEALTH OUTPATIENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR,FINANCE AND HUMAN RESOURCE
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-327-0132
Mailing Address - Street 1:PO BOX 3488
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52808-3488
Mailing Address - Country:US
Mailing Address - Phone:563-327-0132
Mailing Address - Fax:563-326-1400
Practice Address - Street 1:1820 W 3RD ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52802-1812
Practice Address - Country:US
Practice Address - Phone:563-322-2103
Practice Address - Fax:563-322-2117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service