MEDICARE: GORDRELL ENTERPRISES LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	343900000X	Non-emergency Medical Transport (VAN)
2	347B00000X	Bus
3	347E00000X	Transportation Broker
4	347C00000X	Private Vehicle

General Provider Information

NPI Number	:	1578179982
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GORDRELL ENTERPRISES LLC

Provider Business Mailing Address
First Line	:	2244 S HAMILTON RD STE 101C
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43232-4390
Country	:	US
Telephone Number	:	855-519-2787
Fax Number	:

Provider Business Practice Location Address
First Line	:	2244 S HAMILTON RD STE 101C
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43232-4390
Country	:	US
Telephone Number	:	855-519-2787
Fax Number	:	614-868-1688

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	TOMIKA GORDON
Credential	:
Telephone Number	:	614-946-5504

Provider Enumeration Date	:	09/21/2020
Last Update Date	:	09/21/2020

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