1881694305 NPI number — MS. ROBERTA J GUIBORD DO

Table of content: MS. ROBERTA J GUIBORD DO (NPI 1881694305)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881694305 NPI number — MS. ROBERTA J GUIBORD DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUIBORD
Provider First Name:
ROBERTA
Provider Middle Name:
J
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1881694305
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 W S BOUNDARY ST
Provider Second Line Business Mailing Address:
BUILDING 3B
Provider Business Mailing Address City Name:
PERRYSBURG
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43551-5230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-872-5556
Provider Business Mailing Address Fax Number:
419-872-5559

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 W S BOUNDARY ST
Provider Second Line Business Practice Location Address:
BUILDING 3B
Provider Business Practice Location Address City Name:
PERRYSBURG
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43551-5230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-872-5556
Provider Business Practice Location Address Fax Number:
419-872-5559
Provider Enumeration Date:
07/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  5868 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207P00000X , with the licence number: 34.005868 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0995839 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 930122301 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: RO9364491 . This is a "MEDICARE ID # GROUP" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000271434 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 810547599067 . This is a "CARESOURCE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 4436166 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: GU4090794 . This is a "MEDICARE ID # INDIVIDUAL" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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