Organization Active NPI

Tennessee Breast Center, Inc

  • Diagnostic Radiology Physician
  • Maryville, TN
National Provider Identifier
1376759852
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
0234636 Issued in TN
Legal business name
TENNESSEE BREAST CENTER, INC
Practice address
1111 E Lamar Alexander Pkwy
Maryville, TN 37804-5130
Phone
(865) 984-9282
Fax
(865) 981-1716
NPI assigned
May 14, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Melissa E Trekell, M.D.,FACS, M.B.A.
Title
President
Phone
(856) 984-9282

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X 0234636 TN Primary

Addresses

Primary practice location

1111 E Lamar Alexander Pkwy
Maryville, TN 37804-5130

Mailing address

1111 E Lamar Alexander Pkwy
Maryville, TN 37804-5130
Phone (865) 984-9282

Other identifiers 1

IdentifierTypeStateIssuer
3730971MedicaidTN

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1376759852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 E LAMAR ALEXANDER PKWY",
            "city": "MARYVILLE",
            "state": "TN",
            "postal_code": "378045130",
            "telephone_number": "865-984-9282",
            "fax_number": "865-981-1716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 E LAMAR ALEXANDER PKWY",
            "city": "MARYVILLE",
            "state": "TN",
            "postal_code": "378045130",
            "telephone_number": "865-984-9282",
            "fax_number": "865-981-1716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TENNESSEE BREAST CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TREKELL",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "856-984-9282",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D.,FACS, M.B.A."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TN",
            "license": "0234636",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3730971",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Maryville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.