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Mark Anthony Gardon

Internal Medicine

Allopathic & Osteopathic Physicians

200 E Chestnut St Ste 303, Louisville, KY 40202-1831

PECOS Enrollment

This provider is enrolled in PECOS as MARK GARDON.

Based on the most recent information from CMS, provider Mark Anthony Gardon is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1134707235
Provider Type
Individual
Full Name
Gardon, Mark Anthony
Gender
Male

Sole Proprietor
No
Enumeration Date
3/30/2021
Last Updated
7/31/2024

Contact Information

Practice Location

200 E Chestnut St Ste 303, Louisville, KY 40202-1831

(502) 629-5552

Unlisted Fax

Mailing Location

PO Box 776351, Chicago, IL 60677-6351

(502) 559-9425

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 207R00000X Primary	Description Internal Medicine Allopathic & Osteopathic Physicians	License 05853 Kentucky
Code 390200000X	Description Student in an Organized Health Care Education/Training Program Student, Health Care	License Unlisted Issuer

Provider Identifiers

ID	Description	Issuer
ID 7100845360	Description Medicaid	Issuer Unlisted Kentucky

Mark Anthony Gardon

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

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