Healthcare Provider Details

I. General information

NPI: 1518938208
Provider Name (Legal Business Name): BREAK THRU MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 01/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 CHURCH ST
MOUNT CLEMENS MI
48043-2186
US

IV. Provider business mailing address

350 CHURCH ST
MOUNT CLEMENS MI
48043-2186
US

V. Phone/Fax

Practice location:
  • Phone: 586-469-1700
  • Fax: 586-469-1703
Mailing address:
  • Phone: 586-469-1700
  • Fax: 586-469-1703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. SALVADOR P PLACENCIA
Title or Position: PRESIDENT
Credential:
Phone: 586-469-1700