1013124213 NPI number — GORDIAN MEDICAL, INC.

Table of content: (NPI 1013124213)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013124213 NPI number — GORDIAN MEDICAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GORDIAN MEDICAL, 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:
Provider Other Organization Name Type Code:
6
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:
1013124213
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2024
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:
877-380-8282

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
750 THE CITY DR S STE 225
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92868-4976
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-556-0200
Provider Business Practice Location Address Fax Number:
877-380-8282
Provider Enumeration Date:
05/17/2007

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

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

  • Identifier: 1013124213 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1508028 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1886211 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2449249 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9164030 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: GM72832 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1013124213 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1013124213 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 500621516 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 057817300 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 06336001 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10025734601 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1013124213 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1013124213 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200570340A . This is a "MEDICAID - QMB" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 250016273 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 375389 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008097518 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110087981A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 127642500 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".




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