Healthcare Provider Details

I. General information

NPI: 1740611789
Provider Name (Legal Business Name): GUARDIAN ANESTHESIA SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2013
Last Update Date: 04/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 NW 88TH ST
KANSAS CITY MO
64154-2700
US

IV. Provider business mailing address

PO BOX 413186
KANSAS CITY MO
64141-3186
US

V. Phone/Fax

Practice location:
  • Phone: 816-420-3939
  • Fax:
Mailing address:
  • Phone: 888-243-4478
  • Fax: 913-647-0575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number078933
License Number StateMO

VIII. Authorized Official

Name: ELISA A MCKAY
Title or Position: PRESIDENT/AUTHORIZED OFFICIAL
Credential: CRNA
Phone: 913-262-2277