Healthcare Provider Details

I. General information

NPI: 1215267513
Provider Name (Legal Business Name): GUARDIAN ANESTHESIA SERVICES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2010
Last Update Date: 09/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 DIANE LN
CONWAY AR
72034-9362
US

IV. Provider business mailing address

725 DIANE LN
CONWAY AR
72034-9362
US

V. Phone/Fax

Practice location:
  • Phone: 501-513-1185
  • Fax: 501-513-1186
Mailing address:
  • Phone: 501-513-1185
  • Fax: 501-513-1186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberC00583
License Number StateAR

VIII. Authorized Official

Name: MR. MICHAEL L LEMLEY
Title or Position: OWNER
Credential: CRNA
Phone: 501-513-1185