Healthcare Provider Details

I. General information

NPI: 1588089718
Provider Name (Legal Business Name): GORMAN MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2014
Last Update Date: 10/20/2023
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8540 SCARBOROUGH DR STE 370
COLORADO SPRINGS CO
80920-7519
US

IV. Provider business mailing address

PO BOX 62669
COLORADO SPRINGS CO
80962-2669
US

V. Phone/Fax

Practice location:
  • Phone: 719-358-8270
  • Fax: 719-358-8299
Mailing address:
  • Phone: 719-219-2400
  • Fax: 719-219-2409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number10199
License Number StateCO

VIII. Authorized Official

Name: FRANCES J GORMAN
Title or Position: OWNER / PROVIDER
Credential:
Phone: 719-313-6028