Basic Information
| Provider Information | |||||||||
| NPI: | 1104194562 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GUARDIAN ANESTHESIA SERVICES PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1002 GEMINI ST | ||||||||
| Address2: | SUITE 128 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770582746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812189515 | ||||||||
| FaxNumber: | 2812189534 | ||||||||
| Practice Location | |||||||||
| Address1: | 1002 GEMINI ST | ||||||||
| Address2: | SUITE 128 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770582746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812189515 | ||||||||
| FaxNumber: | 2812189534 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2011 | ||||||||
| LastUpdateDate: | 11/13/2012 | ||||||||
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| AuthorizedOfficialLastName: | KOONS | ||||||||
| AuthorizedOfficialFirstName: | PATRICK | ||||||||
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| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 2812189515 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 207L00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.