Provider Demographics
NPI:1265435846
Name:GOLDEN MEDICAL, INC.
Entity type:Organization
Organization Name:GOLDEN MEDICAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:NONE
Authorized Official - Last Name:BERNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-338-8286
Mailing Address - Street 1:2600 CENTRAL AVE
Mailing Address - Street 2:STE F
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-6211
Mailing Address - Country:US
Mailing Address - Phone:620-338-8286
Mailing Address - Fax:620-338-8287
Practice Address - Street 1:2600 CENTRAL AVE
Practice Address - Street 2:STE F
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-6211
Practice Address - Country:US
Practice Address - Phone:620-338-8286
Practice Address - Fax:620-338-8287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NOT REQUIRED332BP3500X, 332BX2000X, 332B00000X
KSBOC # C17759335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS048572OtherBLUE CROSS/BLUE SHIELD
KS048572OtherBLUE CROSS/BLUE SHIELD