MEDICARE: GOLDEN MEDICAL, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	NOT REQUIRED
2	332BX2000X	Oxygen Equipment & Supplies (DME)	NOT REQUIRED
3	335E00000X	Prosthetic/Orthotic Supplier	BOC # C17759	KS
4	332B00000X	Durable Medical Equipment & Medical Supplies	NOT REQUIRED

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	048572	OTHER	KS	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1265435846
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN MEDICAL, INC.

Provider Business Mailing Address
First Line	:	2600 CENTRAL AVE
Second Line	:	STE F
City	:	DODGE CITY
State	:	KS
Zip	:	67801-6211
Country	:	US
Telephone Number	:	620-338-8286
Fax Number	:	620-338-8287

Provider Business Practice Location Address
First Line	:	2600 CENTRAL AVE
Second Line	:	STE F
City	:	DODGE CITY
State	:	KS
Zip	:	67801-6211
Country	:	US
Telephone Number	:	620-338-8286
Fax Number	:	620-338-8287

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. JEAN NONE BERNING
Credential	:
Telephone Number	:	620-338-8286

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	11/09/2007

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Directions to “GOLDEN MEDICAL, INC. ” Practice Location

Language	Start Address	Practice Location

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