MEDICARE: BREAKEY PROSTHETICS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952301640
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BREAKEY PROSTHETICS, INC.

Provider Business Mailing Address
First Line	:	820 MALONE RD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95125-2639
Country	:	US
Telephone Number	:	408-723-0883
Fax Number	:	408-723-0890

Provider Business Practice Location Address
First Line	:	820 MALONE RD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95125-2639
Country	:	US
Telephone Number	:	408-723-0883
Fax Number	:	408-723-0890

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MIKE DENNIS GIDDING
Credential	:	CP
Telephone Number	:	408-723-0883

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	09/30/2012

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