MEDICARE: G MEDICAL DIAGNOSTIC SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	293D00000X	Physiological Laboratory

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0488DC	OTHER	TX	BCBS TX
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114948445
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	G MEDICAL DIAGNOSTIC SERVICES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 2153 DEPT 1840
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35287-1840
Country	:	US
Telephone Number	:	800-595-2898
Fax Number	:	888-965-7697

Provider Business Practice Location Address
First Line	:	12708 RIATA VISTA CIR STE A103
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78727-7174
Country	:	US
Telephone Number	:	800-595-2898
Fax Number	:	512-212-9490

Authorized Official
Title or Position	:	DISTRIBUTION MANAGER
Name	:	MR. TIM LOHMAN
Credential	:
Telephone Number	:	512-212-5508

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	03/05/2024

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