Provider Demographics
NPI:1992162911
Name:GORDIAN MEDICAL IV, INC.
Entity type:Organization
Organization Name:GORDIAN MEDICAL IV, 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:714-556-0200
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 1:3610 CENTRAL AVE, FLOOR 4 SUITE 40
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-5900
Practice Address - Country:US
Practice Address - Phone:951-736-9000
Practice Address - Fax:877-380-8282
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GORDIAN MEDICAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-21
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1992162911Medicaid
CO1992162911Medicaid
MT1992162911Medicaid
AL246478Medicaid
MI1992162911Medicaid
NM59557206Medicaid
OH0228912Medicaid
AZ092120Medicaid
UT1992162911Medicaid
NV250016853Medicaid
NE10026672800Medicaid
IA1221084Medicaid
NC1992162911Medicaid
OK200711680AMedicaid
KS201159940AMedicaid
NY05171664Medicaid
CA1992162911Medicaid
ID1992162911Medicaid
OR500775991Medicaid
MS08724809Medicaid
VT1030817Medicaid
PA1033562880001Medicaid
WY146619400Medicaid
AK1722491Medicaid
WA2083657Medicaid
MD300286100Medicaid
SCDM1587Medicaid