Provider Demographics
NPI:1477715100
Name:GOULD'S DISCOUNT MEDICAL LLC
Entity Type:Organization
Organization Name:GOULD'S DISCOUNT MEDICAL LLC
Other - Org Name:GOULD'S DISCOUNT MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSALESI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-246-9499
Mailing Address - Street 1:220 W GERMANTOWN PIKE STE 250
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1437
Mailing Address - Country:US
Mailing Address - Phone:502-491-2000
Mailing Address - Fax:502-495-2476
Practice Address - Street 1:7098 DISTRIBUTION DR STE E
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40258-2879
Practice Address - Country:US
Practice Address - Phone:502-935-1100
Practice Address - Fax:502-371-0856
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOULD'S DISCOUNT MEDICAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-25
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY169688332B00000X
IN69001017A332B00000X
332BC3200X, 335E00000X
KYMG0683332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100229660Medicaid
KY7100229660Medicaid