Xtreme Prosthetics LLC.

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

License

135770 Issued in KY

Legal business name

XTREME PROSTHETICS LLC.

Practice address

400 S Broadway St
Glasgow, KY 42141-2502

Phone

(270) 629-5462

NPI assigned

Dec 13, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Bradford Neil Gardner

Title

Director

Phone

(615) 864-8783

Specialties & licenses 1

Addresses

Other names 1

• ForMotion Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Xtreme Prosthetics, LLC.

  • Prosthetic/Orthotic Supplier
  • Bowling Green, KY
  • NPI 1225703838

  7214125657

  Same PAC ID
• Xtreme Prosthetics, LLC.

  • Prosthetic/Orthotic Supplier
  • Somerset, KY
  • NPI 1245534585

  7214125657

  Same PAC ID

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Tax ID family

Formotion Clinic3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Xtreme Prosthetics, LLC.

  • Prosthetic/Orthotic Supplier
  • Bowling Green, KY
  • NPI 1225703838
  NPD tax ID
• Xtreme Prosthetics, LLC.

  • Prosthetic/Orthotic Supplier
  • Somerset, KY
  • NPI 1245534585
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1481587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1780012800000",
    "number": "1992249718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 WOODMONT BLVD STE 400",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372055217",
            "telephone_number": "615-550-8774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 S BROADWAY ST",
            "city": "GLASGOW",
            "state": "KY",
            "postal_code": "421412502",
            "telephone_number": "270-629-5462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "XTREME PROSTHETICS LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-13",
        "last_updated": "2026-05-29",
        "certification_date": "2026-05-29",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "BRADFORD",
        "authorized_official_middle_name": "NEIL",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "615-864-8783"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "KY",
            "license": "135770",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ForMotion Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Wound Care Center at Glasgow
• Brandon Wray
• Kristina Lynn Wright-Gue, DO
• Hannah Wright, LCPM
• Rondal Brent Wright, M.D.
• Zhixing Yao, MD
• Avery York
• Cecily Renee York, CADC
• Marsha York, LMFT
• Paul Sandidge York Jr., M.D.

• Prosthetic/Orthotic Supplier in Glasgow, KY
• Providers in Glasgow, KY by specialty
• Prosthetic/Orthotic Supplier in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.