Provider Demographics
NPI:1609508845
Name:GORMAN MEDICAL LLC
Entity Type:Organization
Organization Name:GORMAN MEDICAL LLC
Other - Org Name:GORMAN MEDICAL CRIPPLE CREEK VICTOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL / OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:J
Authorized Official - Last Name:GORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:719-313-6028
Mailing Address - Street 1:PO BOX 62669
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80962-2669
Mailing Address - Country:US
Mailing Address - Phone:719-219-2400
Mailing Address - Fax:719-219-2409
Practice Address - Street 1:412 N C ST
Practice Address - Street 2:
Practice Address - City:CRIPPLE CREEK
Practice Address - State:CO
Practice Address - Zip Code:80813-5052
Practice Address - Country:US
Practice Address - Phone:719-358-8270
Practice Address - Fax:719-358-8299
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GORMAN MEDICAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-27
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LS0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerSchoolGroup - Multi-Specialty