1033436746 NPI number — GORDIAN MEDICAL VI, INC.

Table of content: (NPI 1033436746)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033436746 NPI number — GORDIAN MEDICAL VI, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GORDIAN MEDICAL VI, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AMERICAN MEDICAL TECHNOLOGIES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033436746
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
750 THE CITY DR S STE 225
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORANGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92868-4976
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-556-0200
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
119 B FORTUNE DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKFORT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40601-8335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-251-4546
Provider Business Practice Location Address Fax Number:
877-380-8282
Provider Enumeration Date:
04/21/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BOWMAN
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
714-556-0200

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  79802 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1031033 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 12155808-1714 . This is a "DME LICENSE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 7100727700 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: DME-001178 . This is a "DME LICENSE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 1033436746 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1033436746 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 19937 . This is a "DME LICENSE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 5306006642 . This is a "DME LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 6000010193 . This is a "DME LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: C002028 . This is a "DME LICENSE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: MP01418 . This is a "DME LICENSE" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 0237000510 . This is a "DME LICENSE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 10026664300 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1033436746 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CSW.0003864 . This is a "DME LICENSE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 08414 . This is a "DME LICENSE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 10334636746 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 113191 . This is a "DME LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 200703340A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100136342 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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