Provider Demographics
NPI:1649726662
Name:GOLDEN MEDICAL, LLC
Entity type:Organization
Organization Name:GOLDEN MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:COLLIN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BOURGEOIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-334-2370
Mailing Address - Street 1:1107 HALSTEAD BAYOU DR
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-5346
Mailing Address - Country:US
Mailing Address - Phone:228-334-2370
Mailing Address - Fax:
Practice Address - Street 1:2113 GOVERNMENT ST
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3954
Practice Address - Country:US
Practice Address - Phone:228-334-2370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies