Provider Demographics
NPI:1033102785
Name:GUILLARD INTERNAL MEDICINE INC.
Entity Type:Organization
Organization Name:GUILLARD INTERNAL MEDICINE INC.
Other - Org Name:HALL GUILLARD GUILLARD & ASSOCIATES, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:GUILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-237-3122
Mailing Address - Street 1:905 UNIVERSITY DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-6626
Mailing Address - Country:US
Mailing Address - Phone:814-237-3122
Mailing Address - Fax:814-237-4050
Practice Address - Street 1:905 UNIVERSITY DR
Practice Address - Street 2:SUITE 1
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-6626
Practice Address - Country:US
Practice Address - Phone:814-237-3122
Practice Address - Fax:814-237-4050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-29
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00068022900003Medicaid
PACF3479OtherRAILROAD MEDICARE
PA39D0688402OtherCLIA
PA10085OtherGEISINGER HEALTH PLAN
PA02276900OtherCAIC/CAPITAL BLUE CROSS
PA518386Medicare ID - Type Unspecified
PA00068022900003Medicaid