Provider Demographics
NPI:1427147412
Name:GUARDIAN HEALTH SYSTEMS
Entity type:Organization
Organization Name:GUARDIAN HEALTH SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:R
Authorized Official - Last Name:MUNN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:214-221-8181
Mailing Address - Street 1:2508 OAK LAWN AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219
Mailing Address - Country:US
Mailing Address - Phone:214-221-8181
Mailing Address - Fax:214-221-8282
Practice Address - Street 1:2508 OAK LAWN AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219
Practice Address - Country:US
Practice Address - Phone:214-221-8181
Practice Address - Fax:214-221-8282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4509014332B00000X, 333600000X
UT45090143336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered333600000XSuppliersPharmacy
Not Answered3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN750176OtherBLUE CROSS BLUE SHIELD
TX0428290001Medicare ID - Type Unspecified