Provider Demographics
NPI:1518938208
Name:BREAK THRU MEDICAL LLC
Entity Type:Organization
Organization Name:BREAK THRU MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SALVADOR
Authorized Official - Middle Name:P
Authorized Official - Last Name:PLACENCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-469-1700
Mailing Address - Street 1:350 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-2186
Mailing Address - Country:US
Mailing Address - Phone:586-469-1700
Mailing Address - Fax:586-469-1703
Practice Address - Street 1:350 CHURCH ST
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2186
Practice Address - Country:US
Practice Address - Phone:586-469-1700
Practice Address - Fax:586-469-1703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4473230Medicaid
MI4473230Medicaid