Provider Demographics
NPI:1801900055
Name:NASHVILLE BREAST CENTER
Entity type:Organization
Organization Name:NASHVILLE BREAST CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-620-5535
Mailing Address - Street 1:300 20TH AVE N STE 401
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2121
Mailing Address - Country:US
Mailing Address - Phone:615-620-5535
Mailing Address - Fax:
Practice Address - Street 1:300 20TH AVE N STE 401
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2121
Practice Address - Country:US
Practice Address - Phone:615-620-5535
Practice Address - Fax:615-284-7794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21350208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3822006Medicaid
TN3162057OtherBLUE CROSS BLUE SHIELD
TN3822006Medicaid