Healthcare Provider Details

I. General information

NPI: 1033436746
Provider Name (Legal Business Name): GORDIAN MEDICAL VI, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2010
Last Update Date: 03/15/2024
Certification Date: 03/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 B FORTUNE DRIVE
FRANKFORT KY
40601-8335
US

IV. Provider business mailing address

750 THE CITY DR S STE 225
ORANGE CA
92868-4976
US

V. Phone/Fax

Practice location:
  • Phone: 502-251-4546
  • Fax: 877-380-8282
Mailing address:
  • Phone: 714-556-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number79802
License Number StateCA

VIII. Authorized Official

Name: JEFFREY BOWMAN
Title or Position: PRESIDENT
Credential:
Phone: 714-556-0200