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  7. NPI Record 1033436746

AMERICAN MEDICAL TECHNOLOGIES
Complete NPI Record 1033436746
Durable Medical Equipment & Medical Supplies in Frankfort, KY

NPI Status: Active since April 21, 2010

Contact Information

119 B FORTUNE DRIVE
FRANKFORT, KY
ZIP 40601
Phone: (502) 251-4546
Fax: (877) 380-8282

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider Other Organization Name
  6. Provider Other Organization Name Type Code
  7. Provider First Line Business Mailing Address
  8. Provider Business Mailing Address City Name
  9. Provider Business Mailing Address State Name
  10. Provider Business Mailing Address Postal Code
  11. Provider Business Mailing Address Country Code If outside U S
  12. Provider Business Mailing Address Telephone Number
  13. Provider First Line Business Practice Location Address
  14. Provider Business Practice Location Address City Name
  15. Provider Business Practice Location Address State Name
  16. Provider Business Practice Location Address Postal Code
  17. Provider Business Practice Location Address Country Code If outside U S
  18. Provider Business Practice Location Address Telephone Number
  19. Provider Business Practice Location Address Fax Number
  20. Provider Enumeration Date
  21. Last Update Date
  22. Authorized Official Last Name
  23. Authorized Official First Name
  24. Authorized Official Title or Position
  25. Authorized Official Telephone Number
  26. Healthcare Provider Taxonomy Code 1
  27. Provider License Number 1
  28. Provider License Number State Code 1
  29. Healthcare Provider Primary Taxonomy Switch 1
  30. Other Provider Identifier 1
  31. Other Provider Identifier Type Code 1
  32. Other Provider Identifier State 1
  33. Other Provider Identifier 2
  34. Other Provider Identifier Type Code 2
  35. Other Provider Identifier State 2
  36. Other Provider Identifier Issuer 2
  37. Other Provider Identifier 3
  38. Other Provider Identifier Type Code 3
  39. Other Provider Identifier State 3
  40. Other Provider Identifier 4
  41. Other Provider Identifier Type Code 4
  42. Other Provider Identifier State 4
  43. Other Provider Identifier Issuer 4
  44. Other Provider Identifier 5
  45. Other Provider Identifier Type Code 5
  46. Other Provider Identifier State 5
  47. Other Provider Identifier 6
  48. Other Provider Identifier Type Code 6
  49. Other Provider Identifier State 6
  50. Other Provider Identifier 7
  51. Other Provider Identifier Type Code 7
  52. Other Provider Identifier State 7
  53. Other Provider Identifier Issuer 7
  54. Other Provider Identifier 8
  55. Other Provider Identifier Type Code 8
  56. Other Provider Identifier State 8
  57. Other Provider Identifier Issuer 8
  58. Other Provider Identifier 9
  59. Other Provider Identifier Type Code 9
  60. Other Provider Identifier State 9
  61. Other Provider Identifier Issuer 9
  62. Other Provider Identifier 10
  63. Other Provider Identifier Type Code 10
  64. Other Provider Identifier State 10
  65. Other Provider Identifier Issuer 10
  66. Other Provider Identifier 11
  67. Other Provider Identifier Type Code 11
  68. Other Provider Identifier State 11
  69. Other Provider Identifier Issuer 11
  70. Other Provider Identifier 12
  71. Other Provider Identifier Type Code 12
  72. Other Provider Identifier State 12
  73. Other Provider Identifier Issuer 12
  74. Other Provider Identifier 13
  75. Other Provider Identifier Type Code 13
  76. Other Provider Identifier State 13
  77. Other Provider Identifier 14
  78. Other Provider Identifier Type Code 14
  79. Other Provider Identifier State 14
  80. Other Provider Identifier 15
  81. Other Provider Identifier Type Code 15
  82. Other Provider Identifier State 15
  83. Other Provider Identifier Issuer 15
  84. Other Provider Identifier 16
  85. Other Provider Identifier Type Code 16
  86. Other Provider Identifier State 16
  87. Other Provider Identifier Issuer 16
  88. Other Provider Identifier 17
  89. Other Provider Identifier Type Code 17
  90. Other Provider Identifier State 17
  91. Other Provider Identifier 18
  92. Other Provider Identifier Type Code 18
  93. Other Provider Identifier State 18
  94. Other Provider Identifier Issuer 18
  95. Other Provider Identifier 19
  96. Other Provider Identifier Type Code 19
  97. Other Provider Identifier State 19
  98. Other Provider Identifier 20
  99. Other Provider Identifier Type Code 20
  100. Other Provider Identifier State 20
  101. Other Provider Identifier 21
  102. Other Provider Identifier Type Code 21
  103. Other Provider Identifier State 21
  104. Other Provider Identifier 22
  105. Other Provider Identifier Type Code 22
  106. Other Provider Identifier State 22
  107. Other Provider Identifier Issuer 22
  108. Other Provider Identifier 23
  109. Other Provider Identifier Type Code 23
  110. Other Provider Identifier State 23
  111. Other Provider Identifier 24
  112. Other Provider Identifier Type Code 24
  113. Other Provider Identifier State 24
  114. Other Provider Identifier Issuer 24
  115. Other Provider Identifier 25
  116. Other Provider Identifier Type Code 25
  117. Other Provider Identifier State 25
  118. Other Provider Identifier 26
  119. Other Provider Identifier Type Code 26
  120. Other Provider Identifier State 26
  121. Other Provider Identifier Issuer 26
  122. Other Provider Identifier 27
  123. Other Provider Identifier Type Code 27
  124. Other Provider Identifier State 27
  125. Other Provider Identifier 28
  126. Other Provider Identifier Type Code 28
  127. Other Provider Identifier State 28
  128. Other Provider Identifier 29
  129. Other Provider Identifier Type Code 29
  130. Other Provider Identifier State 29
  131. Other Provider Identifier Issuer 29
  132. Other Provider Identifier 30
  133. Other Provider Identifier Type Code 30
  134. Other Provider Identifier State 30
  135. Other Provider Identifier 31
  136. Other Provider Identifier Type Code 31
  137. Other Provider Identifier State 31
  138. Other Provider Identifier 32
  139. Other Provider Identifier Type Code 32
  140. Other Provider Identifier State 32
  141. Other Provider Identifier Issuer 32
  142. Other Provider Identifier 33
  143. Other Provider Identifier Type Code 33
  144. Other Provider Identifier State 33
  145. Other Provider Identifier 34
  146. Other Provider Identifier Type Code 34
  147. Other Provider Identifier State 34
  148. Other Provider Identifier 35
  149. Other Provider Identifier Type Code 35
  150. Other Provider Identifier State 35
  151. Other Provider Identifier Issuer 35
  152. Other Provider Identifier 36
  153. Other Provider Identifier Type Code 36
  154. Other Provider Identifier State 36
  155. Other Provider Identifier Issuer 36
  156. Is Organization Subpart
  157. Parent Organization LBN
  158. Parent Organization TIN
  159. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1033436746. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1033436746
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider Other Organization Name: AMERICAN MEDICAL TECHNOLOGIES
Other name by which the organization provider is or has been known.
Provider Other Organization Name Type Code: 3
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
Provider First Line Business Mailing Address: 750 THE CITY DR S STE 225
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: ORANGE
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: CA
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 928684976
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 7145560200
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider First Line Business Practice Location Address: 119 B FORTUNE DRIVE
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: FRANKFORT
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: KY
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 406018335
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 5022514546
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 8773808282
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 4/21/2010
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 3/15/2024
The date that a record was last updated or changed.
Authorized Official Last Name: BOWMAN
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: JEFFREY
The first name of the authorized official.
Authorized Official Title or Position: PRESIDENT
The title or position of the authorized official.
Authorized Official Telephone Number: 7145560200
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 332B00000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: 79802
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1: CA
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1: Y
Other Provider Identifier 1: 1031033
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 1: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1: VT
Other Provider Identifier 2: 12155808-1714
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 2: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 2: UT
Other Provider Identifier Issuer 2: DME LICENSE
Other Provider Identifier 3: 7100727700
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 3: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 3: KY
Other Provider Identifier 4: DME-001178
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 4: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 4: HI
Other Provider Identifier Issuer 4: DME LICENSE
Other Provider Identifier 5: 1033436746
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 5: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 5: MI
Other Provider Identifier 6: 1033436746
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 6: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 6: ID
Other Provider Identifier 7: 19937
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 7: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 7: SC
Other Provider Identifier Issuer 7: DME LICENSE
Other Provider Identifier 8: 5306006642
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 8: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 8: MI
Other Provider Identifier Issuer 8: DME LICENSE
Other Provider Identifier 9: 6000010193
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 9: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 9: PA
Other Provider Identifier Issuer 9: DME LICENSE
Other Provider Identifier 10: C002028
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 10: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 10: AZ
Other Provider Identifier Issuer 10: DME LICENSE
Other Provider Identifier 11: MP01418
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 11: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 11: NV
Other Provider Identifier Issuer 11: DME LICENSE
Other Provider Identifier 12: 0237000510
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 12: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 12: VA
Other Provider Identifier Issuer 12: DME LICENSE
Other Provider Identifier 13: 10026664300
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 13: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 13: NE
Other Provider Identifier 14: 1033436746
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 14: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 14: CA
Other Provider Identifier 15: CSW.0003864
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 15: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 15: CT
Other Provider Identifier Issuer 15: DME LICENSE
Other Provider Identifier 16: 08414
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 16: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 16: NH
Other Provider Identifier Issuer 16: DME LICENSE
Other Provider Identifier 17: 10334636746
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 17: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 17: OR
Other Provider Identifier 18: 113191
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 18: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 18: CA
Other Provider Identifier Issuer 18: DME LICENSE
Other Provider Identifier 19: 200703340A
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 19: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 19: OK
Other Provider Identifier 20: 100136342
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 20: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 20: WI
Other Provider Identifier 21: 1033436746
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 21: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 21: WY
Other Provider Identifier 22: WHOL2496
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 22: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 22: ND
Other Provider Identifier Issuer 22: DME LICENSE
Other Provider Identifier 23: 0000735607
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 23: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 23: MT
Other Provider Identifier 24: 15061-11.1
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 24: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 24: MS
Other Provider Identifier Issuer 24: DME LICENSE
Other Provider Identifier 25: 201155740A
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 25: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 25: KS
Other Provider Identifier 26: 265899
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 26: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 26: KY
Other Provider Identifier Issuer 26: DME LICENSE
Other Provider Identifier 27: 66276322
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 27: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 27: NM
Other Provider Identifier 28: DM1586
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 28: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 28: SC
Other Provider Identifier 29: DME62779
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 29: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 29: ID
Other Provider Identifier Issuer 29: DME LICENSE
Other Provider Identifier 30: 1033436746
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 30: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 30: CO
Other Provider Identifier 31: 1033436746
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 31: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 31: UT
Other Provider Identifier 32: 203002688
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 32: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 32: IL
Other Provider Identifier Issuer 32: DME LICENSE
Other Provider Identifier 33: 2082372
Other Provider Identifier Type Code 33: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 33: WA
Other Provider Identifier 34: 262317
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 34: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 34: AZ
Other Provider Identifier 35: 69001671A
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 35: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 35: IN
Other Provider Identifier Issuer 35: DME LICENSE
Other Provider Identifier 36: PHDME000706
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 36: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 36: GA
Other Provider Identifier Issuer 36: DME LICENSE
Is Organization Subpart: Y
Parent Organization LBN: GORDIAN MEDICAL, INC.
Parent Organization TIN: UNAVAIL
NPI Certification Date: 3/15/2024