Provider Demographics
NPI:1750888335
Name:GOULD ENTERPRISE, PLLC
Entity type:Organization
Organization Name:GOULD ENTERPRISE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SOLOMON
Authorized Official - Middle Name:M
Authorized Official - Last Name:GOULD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-739-5173
Mailing Address - Street 1:1995 BURNS AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55119-4906
Mailing Address - Country:US
Mailing Address - Phone:651-739-5173
Mailing Address - Fax:651-739-8907
Practice Address - Street 1:1995 BURNS AVE STE B
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55119
Practice Address - Country:US
Practice Address - Phone:651-739-5173
Practice Address - Fax:651-739-8907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-10
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3415OtherMN LICENSE
MN1518232149OtherTYPE I NPI
1750888335OtherTYPE II NPI