Breakaway, Inc

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

License

047307 Issued in ID

Legal business name

BREAKAWAY, INC

Practice address

106 E 39TH St
Garden City, ID 83714-6440

Phone

(208) 342-4506

Fax

(208) 342-4507

NPI assigned

Feb 28, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Carol C Elliott

Title

Vice-President

Phone

(208) 342-4506

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1204156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322611200000",
    "number": "1700055209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1593",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837011593",
            "telephone_number": "208-342-4506",
            "fax_number": "208-342-4507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 E 39TH ST",
            "city": "GARDEN CITY",
            "state": "ID",
            "postal_code": "837146440",
            "telephone_number": "208-342-4506",
            "fax_number": "208-342-4507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREAKAWAY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-28",
        "last_updated": "2011-11-30",
        "status": "A",
        "authorized_official_last_name": "ELLIOTT",
        "authorized_official_first_name": "CAROL",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "VICE-PRESIDENT",
        "authorized_official_telephone_number": "208-342-4506",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "ID",
            "license": "047307",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8061158",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Customized Equipment (DME) in Garden City, ID
• Providers in Garden City, ID by specialty
• Customized Equipment (DME) in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.