MEDICARE: GOLDEN MEDICAL, LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1649726662
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN MEDICAL, LLC

Provider Business Mailing Address
First Line	:	1107 HALSTEAD BAYOU DR
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-5346
Country	:	US
Telephone Number	:	228-334-2370
Fax Number	:

Provider Business Practice Location Address
First Line	:	2113 GOVERNMENT ST
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-3954
Country	:	US
Telephone Number	:	228-334-2370
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	COLLIN DAVID BOURGEOIS
Credential	:
Telephone Number	:	228-334-2370

Provider Enumeration Date	:	08/30/2016
Last Update Date	:	08/30/2016

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