Provider Demographics
NPI:1497163323
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:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-206-0040
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:541-326-0009
Mailing Address - Fax:502-495-2476
Practice Address - Street 1:2408 RING RD
Practice Address - Street 2:SUITE 600
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-7938
Practice Address - Country:US
Practice Address - Phone:270-506-0033
Practice Address - Fax:270-209-0890
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOULD'S DISCOUNT MEDICAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-23
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY170285332B00000X
332BC3200X
KYMG0874332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100386070Medicaid
KY15825OtherELIZABETHTOWN BUSINESS LICENSE
KY15825OtherELIZABETHTOWN BUSINESS LICENSE