Provider Demographics
NPI:1194920066
Name:GUARDIAN ANESTHESIA SERVICES
Entity type:Organization
Organization Name:GUARDIAN ANESTHESIA SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
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:913-754-8508
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:913-754-8508
Mailing Address - Fax:913-647-0575
Practice Address - Street 1:4321 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5961
Practice Address - Country:US
Practice Address - Phone:913-754-8508
Practice Address - Fax:913-647-0575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2020-08-22
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
MOK150000AMedicare ID - Type Unspecified