Healthcare Provider Details

I. General information

NPI: 1124103205
Provider Name (Legal Business Name): GUARDIAN ANESTHESIA SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 10/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 W 75TH ST
PRAIRIE VILLAGE KS
66208-4126
US

IV. Provider business mailing address

PO BOX 413770
KANSAS CITY MO
64141-3770
US

V. Phone/Fax

Practice location:
  • Phone: 913-384-9600
  • Fax: 913-284-9646
Mailing address:
  • Phone: 800-903-2088
  • Fax: 913-696-7141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ELISA A MCKAY
Title or Position: SOLE PROPRIETOR
Credential: CRNA
Phone: 913-262-2277