1225413743 NPI number — GORDIAN MEDICAL V, INC.

Table of content: (NPI 1225413743)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225413743 NPI number — GORDIAN MEDICAL V, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GORDIAN MEDICAL V, 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:
1225413743
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:
832-365-5117
Provider Business Mailing Address Fax Number:
877-380-8282

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9894 BISSONNET ST STE 284
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77036-8376
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-365-5117
Provider Business Practice Location Address Fax Number:
877-380-8282
Provider Enumeration Date:
07/26/2015

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:  1001540 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1038779370001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1225413743 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: MP01520 . This is a "DME LICENSE" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: PHDME000699 . This is a "DME LICENSE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 203002698 . This is a "DME LICENSE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 362093201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: DME-0112 . This is a "DME LICENSE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: DME59406 . This is a "DME LICENSE" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 01331701 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0237000360 . This is a "DME LICENSE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0389768 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 08577 . This is a "DME LICENSE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 100189769 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1225413743 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 07027498 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 16128 . This is a "DME LICENSE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 155146900 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6709193 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7543020001 . This is a "MEDICARE NSC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6000010257 . This is a "DME LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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