Provider Demographics
NPI:1669417531
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:502-491-2000
Mailing Address - Fax:502-736-0848
Practice Address - Street 1:3901 DUTCHMANS LN
Practice Address - Street 2:SUITE 100
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4726
Practice Address - Country:US
Practice Address - Phone:502-491-2000
Practice Address - Fax:502-495-2476
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOULD'S DISCOUNT MEDICAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-17
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN69000969A332B00000X
332BC3200X, 335E00000X
KYMG0059332BX2000X
KY169689332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100191340Medicaid
IN100023330AMedicaid