Provider Demographics
NPI:1225413743
Name:GORDIAN MEDICAL V, INC.
Entity Type:Organization
Organization Name:GORDIAN MEDICAL V, INC.
Other - Org Name:AMERICAN MEDICAL TECHNOLOGIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-556-0200
Mailing Address - Street 1:750 THE CITY DR S STE 225
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4976
Mailing Address - Country:US
Mailing Address - Phone:832-365-5117
Mailing Address - Fax:877-380-8282
Practice Address - Street 1:9894 BISSONNET ST STE 284
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-8376
Practice Address - Country:US
Practice Address - Phone:832-365-5117
Practice Address - Fax:877-380-8282
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GORDIAN MEDICAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-26
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1001540332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1038779370001Medicaid
CA1225413743Medicaid
NVMP01520OtherDME LICENSE
GAPHDME000699OtherDME LICENSE
IL203002698OtherDME LICENSE
TX362093201Medicaid
HIDME-0112OtherDME LICENSE
IDDME59406OtherDME LICENSE
NM01331701Medicaid
VA0237000360OtherDME LICENSE
OH0389768Medicaid
NH08577OtherDME LICENSE
WI100189769Medicaid
UT1225413743Medicaid
NY07027498Medicaid
MS16128OtherDME LICENSE
WY155146900Medicaid
VT6709193Medicaid
7543020001OtherMEDICARE NSC
PA6000010257OtherDME LICENSE
AZC001982OtherDME LICENSE
ME1212170003Medicaid
SCDM1650Medicaid
LADME001185-NROtherDME LICENSE
TX1001898OtherDME LICENSE
CA112100OtherDME LICENSE
MI1225413743Medicaid
WA2155882Medicaid
KY265661OtherDME LICENSE
CTCSW.0004016OtherDME LICENSE