Provider Demographics
NPI:1902085442
Name:GK MEDICAL INC
Entity Type:Organization
Organization Name:GK MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:COF
Authorized Official - Phone:502-899-9177
Mailing Address - Street 1:4850 BROWNSBORO CTR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-2381
Mailing Address - Country:US
Mailing Address - Phone:502-899-9177
Mailing Address - Fax:502-899-9178
Practice Address - Street 1:4850 BROWNSBORO CTR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-2381
Practice Address - Country:US
Practice Address - Phone:502-899-9177
Practice Address - Fax:502-899-9178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
KYCFO00523335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200414920Medicaid
KY90006156Medicaid
KY4593340001Medicare NSC