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General NPI Number Information
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NPI Number | 1225557242
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Entity Type | Organization
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Legal Business Name | LIFEGUARD ANESTHESIA SERVICES LLC
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Dates
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Enumeration Date | 09/11/2017
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Last Update Date | 04/27/2020
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Provider Practice Location Address
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Address Line | 6310 E 102ND ST
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City | TULSA
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State | OK
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Zip | 74137-7061
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Country | US
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Telephone | 870-530-4660
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Fax |
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Provider Business Mailing Address
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Address Line | 5406 E 110TH PL
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City | TULSA
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State | OK
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Zip | 74137-7253
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Country | US
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Telephone | 870-530-4660
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | TIMOTHY GIBSON
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Credential | CRNA
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Telephone | 816-914-2583
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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