Contract Details
Ancillary Care Services
Facility name
Gould's Discount Medical
Provider ID
P000005043
NPI
1669417531
Tax ID
611186938
Effective Date
4/1/2012
Last Updated
10/10/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
3901 Dutchmans Lane
Louisville, KY 40207
United States
County
Jefferson
Phone
5024912000 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address