1821426586 NPI number — GUILLOT ENTERPRISES, LLC

Table of content: (NPI 1821426586)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821426586 NPI number — GUILLOT ENTERPRISES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GUILLOT ENTERPRISES, LLC
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:
AUDIBEL HEARING AND AUDIOLOGY CENTERS
Provider Other Organization Name Type Code:
3
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:
1821426586
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4130 NW 37TH PL
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32606-8152
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-377-4111
Provider Business Mailing Address Fax Number:
352-367-1453

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
536 E 1ST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRESTVIEW
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32536-2505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-398-5091
Provider Business Practice Location Address Fax Number:
850-332-7892
Provider Enumeration Date:
10/16/2013

Additional Information

Authorized Official

Authorized Official Last Name:
GUILLOT
Authorized Official First Name:
TOM
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
352-377-4111

Provider Taxonomy Codes

  • Taxonomy code: 261QH0700X , with the licence number:  AS3902 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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