Provider Demographics
NPI:1598858284
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:408-845-9245
Mailing Address - Street 1:3350 SCOTT BLVD
Mailing Address - Street 2:SUITE 6301
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95054-3109
Mailing Address - Country:US
Mailing Address - Phone:408-845-9245
Mailing Address - Fax:408-845-9259
Practice Address - Street 1:3350 SCOTT BLVD
Practice Address - Street 2:SUITE 6301
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054-3109
Practice Address - Country:US
Practice Address - Phone:408-845-9245
Practice Address - Fax:408-845-9259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACP003200335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA610058700OtherU.S. DEPT OF LABOR
CAZZZ66207ZOtherBLUE SHIELD PIN
CAZZZ66208ZOtherBLUE SHIELD PIN
CAZZZ66208ZOtherBLUE SHIELD PIN