1033102785 NPI number — GUILLARD INTERNAL MEDICINE INC.

Table of content: (NPI 1033102785)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033102785 NPI number — GUILLARD INTERNAL MEDICINE INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GUILLARD INTERNAL MEDICINE INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HALL GUILLARD GUILLARD & ASSOCIATES, INC.
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033102785
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
905 UNIVERSITY DR
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
STATE COLLEGE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16801-6626
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-237-3122
Provider Business Mailing Address Fax Number:
814-237-4050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
905 UNIVERSITY DR
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
STATE COLLEGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16801-6626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-237-3122
Provider Business Practice Location Address Fax Number:
814-237-4050
Provider Enumeration Date:
08/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GUILLARD
Authorized Official First Name:
FRANK
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
814-237-3122

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00068022900003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CF3479 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 39D0688402 . This is a "CLIA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 10085 . This is a "GEISINGER HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02276900 . This is a "CAIC/CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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