Provider Demographics
NPI:1215267513
Name:GUARDIAN ANESTHESIA SERVICES, PA
Entity type:Organization
Organization Name:GUARDIAN ANESTHESIA SERVICES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEMLEY
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:501-513-1185
Mailing Address - Street 1:725 DIANE LN
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-9362
Mailing Address - Country:US
Mailing Address - Phone:501-513-1185
Mailing Address - Fax:501-513-1186
Practice Address - Street 1:725 DIANE LN
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-9362
Practice Address - Country:US
Practice Address - Phone:501-513-1185
Practice Address - Fax:501-513-1186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-08
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC00583367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty