1124103205 NPI number — GUARDIAN ANESTHESIA SERVICES

Table of content: (NPI 1124103205)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124103205 NPI number — GUARDIAN ANESTHESIA SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GUARDIAN ANESTHESIA SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124103205
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 413770
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64141-3770
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-903-2088
Provider Business Mailing Address Fax Number:
913-696-7141

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3840 W 75TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRAIRIE VILLAGE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66208-4126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-384-9600
Provider Business Practice Location Address Fax Number:
913-284-9646
Provider Enumeration Date:
10/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCKAY
Authorized Official First Name:
ELISA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
SOLE PROPRIETOR
Authorized Official Telephone Number:
913-262-2277

Provider Taxonomy Codes

  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200355250A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 500857800 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 27170015 . This is a "BLUE CROSS BLUE SHIELD OF" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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