Provider Demographics
NPI:1316310345
Name:GUILLOT ENTERPRISES LLC
Entity type:Organization
Organization Name:GUILLOT ENTERPRISES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:GUILLOT
Authorized Official - Suffix:
Authorized Official - Credentials:BC HIS
Authorized Official - Phone:352-377-4111
Mailing Address - Street 1:4130 NW 37TH PL
Mailing Address - Street 2:SUITE C
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-8152
Mailing Address - Country:US
Mailing Address - Phone:352-377-4111
Mailing Address - Fax:352-367-1453
Practice Address - Street 1:2209 SANTA BARBARA BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991-4333
Practice Address - Country:US
Practice Address - Phone:239-673-9507
Practice Address - Fax:239-673-9509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS3293261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech