1154344414 NPI number — GORDIAN MEDICAL VIII, INC.

Table of content: (NPI 1154344414)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154344414 NPI number — GORDIAN MEDICAL VIII, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GORDIAN MEDICAL VIII, 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:
1154344414
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:
714-566-0200
Provider Business Mailing Address Fax Number:
877-380-8282

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9000 SHERIDAN ST STE 150
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEMBROKE PINES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33024-8801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-963-8787
Provider Business Practice Location Address Fax Number:
954-963-8724
Provider Enumeration Date:
07/26/2006

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:
714-566-0200

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0674050 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 155557000 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200896770A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 203.00273 . This is a "DME LICENSE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 3016589 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100190354 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42106338 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: DM1653 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 028297900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1154344414 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1154344414 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2156273 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100809440 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300055945 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 028297900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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