Provider Demographics
NPI:1124103205
Name:GUARDIAN ANESTHESIA SERVICES
Entity type:Organization
Organization Name:GUARDIAN ANESTHESIA SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:ELISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCKAY
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:913-262-2277
Mailing Address - Street 1:PO BOX 413770
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64141-3770
Mailing Address - Country:US
Mailing Address - Phone:800-903-2088
Mailing Address - Fax:913-696-7141
Practice Address - Street 1:3840 W 75TH ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-4126
Practice Address - Country:US
Practice Address - Phone:913-384-9600
Practice Address - Fax:913-284-9646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200355250AMedicaid
MO500857800Medicaid
MO27170015OtherBLUE CROSS BLUE SHIELD OF
KSDC2866Medicare PIN
MOK150000AMedicare ID - Type Unspecified
MO27170015OtherBLUE CROSS BLUE SHIELD OF
NE=========15Medicaid
MODD8779Medicare PIN