Basic Information
| Provider Information | |||||||||
| NPI: | 1013946797 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GUARDIAN ANESTHESIA SERVICES, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 960556 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731960556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034229438 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9395 CROWN CREST BLVD | ||||||||
| Address2: | |||||||||
| City: | PARKER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801388573 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3032694000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 07/07/2021 | ||||||||
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| AuthorizedOfficialLastName: | KEEVER | ||||||||
| AuthorizedOfficialFirstName: | ANTHONY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3035245187 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 07/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 08808783 | 05 | CO | MEDICAID |