Healthcare Provider Details

I. General information

NPI: 1194717520
Provider Name (Legal Business Name): GOLDEN STATE MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 LINDEN AVE 100
AUBURN CA
95603-5280
US

IV. Provider business mailing address

PO BOX 300
AUBURN CA
95604-0300
US

V. Phone/Fax

Practice location:
  • Phone: 800-696-2900
  • Fax: 530-885-3631
Mailing address:
  • Phone: 800-696-2900
  • Fax: 530-885-3631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberCO2725
License Number StateCA

VIII. Authorized Official

Name: MR. SCOTT GRAVES
Title or Position: CEO
Credential:
Phone: 800-696-2900