Basic Information
| Provider Information | |||||||||
| NPI: | 1609508845 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GORMAN MEDICAL LLC | ||||||||
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| OtherOrganizationName: | GORMAN MEDICAL CRIPPLE CREEK VICTOR | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 62669 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809622669 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7192192400 | ||||||||
| FaxNumber: | 7192192409 | ||||||||
| Practice Location | |||||||||
| Address1: | 412 N C ST | ||||||||
| Address2: | |||||||||
| City: | CRIPPLE CREEK | ||||||||
| State: | CO | ||||||||
| PostalCode: | 808135052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7193588270 | ||||||||
| FaxNumber: | 7193588299 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2022 | ||||||||
| LastUpdateDate: | 06/27/2022 | ||||||||
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| AuthorizedOfficialLastName: | GORMAN | ||||||||
| AuthorizedOfficialFirstName: | FRANCES | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL / OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7193136028 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | GORMAN MEDICAL LLC | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | NP | ||||||||
| NPICertificationDate: | 06/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LS0200X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | School |
No ID Information.