GORDIAN MEDICAL VI, INC.

Provider Demographics

• NPI: 1033436746
• Name: GORDIAN MEDICAL VI, INC.
• Entity Type: Organization
• Organization Name: GORDIAN MEDICAL VI, INC.
• Other - Org Name: AMERICAN MEDICAL TECHNOLOGIES
• Other - Org Type: Doing Business As
• Authorized Official - Title/Position: PRESIDENT
• Authorized Official - First Name: JEFFREY
• Authorized Official - Last Name: BOWMAN
• Authorized Official - Phone: 714-556-0200
• Mailing Address - Street 1: 750 THE CITY DR S STE 225
• Mailing Address - City: ORANGE
• Mailing Address - State: CA
• Mailing Address - Zip Code: 92868-4976
• Mailing Address - Country: US
• Mailing Address - Phone: 714-556-0200
• Practice Address - Street 1: 119 B FORTUNE DRIVE
• Practice Address - City: FRANKFORT
• Practice Address - State: KY
• Practice Address - Zip Code: 40601-8335
• Practice Address - Country: US
• Practice Address - Phone: 502-251-4546
• Practice Address - Fax: 877-380-8282
• EIN: <UNAVAIL>
• Is Organization Subpart?: Yes
• Parent Organization LBN: GORDIAN MEDICAL, INC.
• Parent Organization TIN: <UNAVAIL>
• Enumeration Date: 2010-04-21
• Last Update Date: 2024-03-15

Provider Licenses

State	License ID	Taxonomies
CA	79802	332B00000X
CA	53865	332B00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	332B00000X	Suppliers	Durable Medical Equipment & Medical Supplies

Provider Identifiers

State	Identifier ID	ID Type	Issuer
VT	1031033	Medicaid
UT	12155808-1714	Other	DME LICENSE
KY	7100727700	Medicaid
HI	DME-001178	Other	DME LICENSE
MI	1033436746	Medicaid
ID	1033436746	Medicaid
SC	19937	Other	DME LICENSE
MI	5306006642	Other	DME LICENSE
PA	6000010193	Other	DME LICENSE
AZ	C002028	Other	DME LICENSE
NV	MP01418	Other	DME LICENSE
VA	0237000510	Other	DME LICENSE
NE	10026664300	Medicaid
CA	1033436746	Medicaid
CT	CSW.0003864	Other	DME LICENSE
NH	08414	Other	DME LICENSE
OR	10334636746	Medicaid
CA	113191	Other	DME LICENSE
OK	200703340A	Medicaid
WI	100136342	Medicaid
WY	1033436746	Medicaid
ND	WHOL2496	Other	DME LICENSE
MT	0000735607	Medicaid
MS	15061-11.1	Other	DME LICENSE
KS	201155740A	Medicaid
KY	265899	Other	DME LICENSE
NM	66276322	Medicaid
SC	DM1586	Medicaid
ID	DME62779	Other	DME LICENSE
CO	1033436746	Medicaid
UT	1033436746	Medicaid
IL	203002688	Other	DME LICENSE
WA	2082372	Medicaid
AZ	262317	Medicaid
IN	69001671A	Other	DME LICENSE
GA	PHDME000706	Other	DME LICENSE