Provider Demographics
NPI:1487097408
Name:GOULD'S DISCOUNT MEDICAL LLC
Entity type:Organization
Organization Name:GOULD'S DISCOUNT MEDICAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:
Mailing Address - Fax:
Practice Address - Street 1:198 MOORE DR
Practice Address - Street 2:SUITE 106
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2944
Practice Address - Country:US
Practice Address - Phone:859-721-1732
Practice Address - Fax:859-201-1296
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOULD'S DISCOUNT MEDICAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-09
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN69001314A332B00000X
332BC3200X
KYMG0843332BX2000X
KY169907332B00000X
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
KY0271240006OtherMEDICARE NSC
KY7100291020Medicaid