Provider Demographics
NPI:1477550192
Name:GORDIAN MEDICAL X, INC.
Entity Type:Organization
Organization Name:GORDIAN MEDICAL X, 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:714-556-0200
Mailing Address - Fax:877-380-8282
Practice Address - Street 1:1097 WESTON DR
Practice Address - Street 2:SUITE B
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122
Practice Address - Country:US
Practice Address - Phone:615-601-3678
Practice Address - Fax:877-380-8282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000803332B00000X
TN34953336C0003X
TN803332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1454461Medicaid
NC1477550192Medicaid
CO9000201041Medicaid
SCDM1681Medicaid
GA003255458AMedicaid
OK201011450AMedicaid
AZ103404Medicaid
AR272542741Medicaid
NM45020850Medicaid
TN5886720001OtherMEDICARE