Basic Information
| Provider Information | |||||||||
| NPI: | 1205989316 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GUARDIAN ANESTHESIA INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 907 SUMNER ST | ||||||||
| Address2: | M201 | ||||||||
| City: | STOUGHTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020723374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7813442325 | ||||||||
| FaxNumber: | 7813418544 | ||||||||
| Practice Location | |||||||||
| Address1: | 907 SUMNER ST | ||||||||
| Address2: | M201 | ||||||||
| City: | STOUGHTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020723374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7813442325 | ||||||||
| FaxNumber: | 7813418544 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | DENEKAMP | ||||||||
| AuthorizedOfficialFirstName: | CINDY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7813442325 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 602146 | 01 | MA | TUFTS | OTHER | CA318643 | 01 | MA | RR MEDICARE | OTHER | M15924 | 01 | MA | BLUE SHIELD MA | OTHER | 9772839 | 05 | MA | MEDICAID |