| Breakaway Health Services Llc | |
|
843 Main St # 15 Manchester CT 06040-6020 | |
| (860) 648-3001 | |
| (860) 648-3003 |
| Full Name | Breakaway Health Services Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 843 Main St # 15, Manchester, Connecticut |
| Authorized Official Name and Position | Tim Bombard (OWNER) |
| Authorized Official Contact | 8602144513 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Breakaway Health Services Llc 694 Palisado Ave Windsor CT 06095-2037 Ph: (860) 214-4513 | Breakaway Health Services Llc 843 Main St # 15 Manchester CT 06040-6020 Ph: (860) 648-3001 |
| NPI Number | 1528777505 |
|---|---|
| Provider Enumeration Date | 11/18/2022 |
| Last Update Date | 12/18/2024 |
| Medicare PECOS PAC ID | 7810429446 |
|---|---|
| Medicare Enrollment ID | O20241021000927 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528777505 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Tim G Bombard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669470993 PECOS PAC ID: 9436042801 Enrollment ID: I20040209000104 |
| Provider Name | Edith Hergan |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1326016726 PECOS PAC ID: 6305811563 Enrollment ID: I20120810000019 |
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