| Breakaway, Llc | |
|
2023 Sw Gage Blvd Topeka KS 66604-3339 | |
| (785) 329-5344 | |
| (785) 329-5625 |
| Full Name | Breakaway, Llc |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 2023 Sw Gage Blvd, Topeka, Kansas |
| Authorized Official Name and Position | Kerry Clemetson (DIRECTOR OF BILLING/CREDENTIALING) |
| Authorized Official Contact | 9134757713 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Breakaway, Llc 2021 Vanesta Pl Ste D Manhattan KS 66503-0381 Ph: (913) 475-7713 | Breakaway, Llc 2023 Sw Gage Blvd Topeka KS 66604-3339 Ph: (785) 329-5344 |
| NPI Number | 1376181149 |
|---|---|
| Provider Enumeration Date | 12/12/2019 |
| Last Update Date | 12/12/2019 |
| Certification Date | 12/12/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376181149 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
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