Healthcare Provider Details

I. General information

NPI: 1609508845
Provider Name (Legal Business Name): GORMAN MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 09/06/2023
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 N C ST
CRIPPLE CREEK CO
80813-5052
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 TaxonomyY
Taxonomy Code363LS0200X
TaxonomySchool Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. FRANCES J GORMAN
Title or Position: AUTHORIZED OFFICIAL / OWNER
Credential: NP
Phone: 719-313-6028