Provider Demographics
NPI:1386941821
Name:GALROB, INC.
Entity type:Organization
Organization Name:GALROB, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYMBERLY
Authorized Official - Middle Name:G
Authorized Official - Last Name:ROBEAU
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:318-876-2800
Mailing Address - Street 1:1408 FRONT ST.
Mailing Address - Street 2:
Mailing Address - City:COTTONPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71327-3540
Mailing Address - Country:US
Mailing Address - Phone:318-876-2800
Mailing Address - Fax:318-876-2803
Practice Address - Street 1:1408 FRONT ST
Practice Address - Street 2:
Practice Address - City:COTTONPORT
Practice Address - State:LA
Practice Address - Zip Code:71327-3514
Practice Address - Country:US
Practice Address - Phone:318-876-2800
Practice Address - Fax:318-876-2803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-18
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
LAAP04351363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1800821Medicaid
LA5DT12Medicare UPIN