Organization Active NPI

Mmi Breast Center, Inc.

  • Diagnostic Radiology Physician
  • Scottsboro, AL
National Provider Identifier
1255384202
Registry record updated Feb 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
MMI BREAST CENTER, INC.
Practice address
1108B S Broad St
Scottsboro, AL 35768-2514
Phone
(256) 574-2883
Fax
(256) 259-9397
NPI assigned
May 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2024

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

Authorized official

Name
Mr. Bart Medlen
Title
Owner
Phone
(256) 574-2883

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

1108B S Broad St
Scottsboro, AL 35768-2514

Mailing address

PO Box 242848
Montgomery, AL 36124-2848
Phone (334) 270-9914

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080125000574 AL Part B Supplier - Clinic/Group Practice 4880614494 Receives reassigned benefits from 2 practitioners
Practice locations: Scottsboro, AL

National Provider Directory

National Provider Directory

Locations

510 Harley St
Scottsboro, AL 35768
Phone (205) 574-2883

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707436800000",
    "number": "1255384202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 242848",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361242848",
            "telephone_number": "334-270-9914",
            "fax_number": "334-270-3195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1108B S BROAD ST",
            "city": "SCOTTSBORO",
            "state": "AL",
            "postal_code": "357682514",
            "telephone_number": "256-574-2883",
            "fax_number": "256-259-9397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MMI BREAST CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-19",
        "last_updated": "2024-02-09",
        "certification_date": "2024-02-09",
        "status": "A",
        "authorized_official_last_name": "MEDLEN",
        "authorized_official_first_name": "BART",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "256-574-2883",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Scottsboro, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.