Provider Demographics
NPI:1154344414
Name:GORDIAN MEDICAL VIII, INC.
Entity type:Organization
Organization Name:GORDIAN MEDICAL VIII, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:714-566-0200
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:714-566-0200
Mailing Address - Fax:877-380-8282
Practice Address - Street 1:9000 SHERIDAN ST STE 150
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-8801
Practice Address - Country:US
Practice Address - Phone:954-963-8787
Practice Address - Fax:954-963-8724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0674050Medicaid
WY155557000Medicaid
OK200896770AMedicaid
IL203.00273OtherDME LICENSE
UT3016589Medicaid
WI100190354Medicaid
NM42106338Medicaid
SCDM1653Medicaid
FL028297900Medicaid
OR1154344414Medicaid
MI1154344414Medicaid
WA2156273Medicaid
KY7100809440Medicaid
IN300055945Medicaid