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905 University Dr Suite 1 State College PA 16801-6626 | |
| (814) 237-3122 | |
| (814) 237-4050 |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 905 University Dr, State College, Pennsylvania |
| Authorized Official Name and Position | Frank Guillard (PRESIDENT) |
| Authorized Official Contact | 8142373122 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
905 University Dr Suite 1 State College PA 16801-6626 Ph: (814) 237-3122 | 905 University Dr Suite 1 State College PA 16801-6626 Ph: (814) 237-3122 |
| NPI Number | 1033102785 |
|---|---|
| Provider Enumeration Date | 08/29/2005 |
| Last Update Date | 09/14/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033102785 | NPI | - | NPPES |
| 00068022900003 | Medicaid | PA | |
| CF3479 | Other | PA | RAILROAD MEDICARE |
| 39D0688402 | Other | PA | CLIA |
| 10085 | Other | PA | GEISINGER HEALTH PLAN |
| 02276900 | Other | PA | CAIC/CAPITAL BLUE CROSS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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