Provider Demographics
NPI:1952301640
Name:BREAKEY PROSTHETICS, INC.
Entity Type:Organization
Organization Name:BREAKEY PROSTHETICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:GIDDING
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:408-723-0883
Mailing Address - Street 1:820 MALONE RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-2639
Mailing Address - Country:US
Mailing Address - Phone:408-723-0883
Mailing Address - Fax:408-723-0890
Practice Address - Street 1:820 MALONE RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-2639
Practice Address - Country:US
Practice Address - Phone:408-723-0883
Practice Address - Fax:408-723-0890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2012-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGFB000040Medicaid
CAGFB000040Medicaid