Basic Information
| Provider Information | |||||||||
| NPI: | 1033102785 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GUILLARD INTERNAL MEDICINE INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HALL GUILLARD GUILLARD & ASSOCIATES, INC. | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 905 UNIVERSITY DR | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | STATE COLLEGE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 168016626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8142373122 | ||||||||
| FaxNumber: | 8142374050 | ||||||||
| Practice Location | |||||||||
| Address1: | 905 UNIVERSITY DR | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | STATE COLLEGE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 168016626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8142373122 | ||||||||
| FaxNumber: | 8142374050 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2005 | ||||||||
| LastUpdateDate: | 09/14/2011 | ||||||||
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| AuthorizedOfficialLastName: | GUILLARD | ||||||||
| AuthorizedOfficialFirstName: | FRANK | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8142373122 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00068022900003 | 05 | PA | MEDICAID | CF3479 | 01 | PA | RAILROAD MEDICARE | OTHER | 39D0688402 | 01 | PA | CLIA | OTHER | 10085 | 01 | PA | GEISINGER HEALTH PLAN | OTHER | 02276900 | 01 | PA | CAIC/CAPITAL BLUE CROSS | OTHER |