Provider Demographics
NPI:1225019334
Name:GORDON HEART CLINIC PC
Entity Type:Organization
Organization Name:GORDON HEART CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-333-0330
Mailing Address - Street 1:5200 PARK AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-3500
Mailing Address - Country:US
Mailing Address - Phone:901-333-0330
Mailing Address - Fax:901-333-0337
Practice Address - Street 1:5200 PARK AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3500
Practice Address - Country:US
Practice Address - Phone:901-333-0330
Practice Address - Fax:901-333-0337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-07
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNE89605Medicare UPIN
TN3730779Medicare PIN