Provider Demographics
NPI:1447402599
Name:PROSTHETIC SOLUTIONS INC.
Entity Type:Organization
Organization Name:PROSTHETIC SOLUTIONS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WADE
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:SKARDOUTOS
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:831-637-0491
Mailing Address - Street 1:191 SAN FELIPE RD STE M1
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-3036
Mailing Address - Country:US
Mailing Address - Phone:831-637-0491
Mailing Address - Fax:831-637-1977
Practice Address - Street 1:191 SAN FELIPE RD STE M1
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-3036
Practice Address - Country:US
Practice Address - Phone:831-637-0491
Practice Address - Fax:831-637-1977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICP003200335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5579810002Medicare NSC