Basic Information
Provider Information
NPI: 1629672027
EntityType: 2
ReplacementNPI:  
OrganizationName: GUARDIAN ANESTHESIA SERVICES, INC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 960556
Address2:  
City: OKLAHOMA CITY
State: OK
PostalCode: 731960556
CountryCode: US
TelephoneNumber: 3034229438
FaxNumber:  
Practice Location
Address1: 15530 E BRONCOS PKWY UNIT 100
Address2:  
City: CENTENNIAL
State: CO
PostalCode: 801127111
CountryCode: US
TelephoneNumber: 7208512000
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/25/2020
LastUpdateDate: 11/25/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: KEEVER
AuthorizedOfficialFirstName: ANTHONY
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 3035245187
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate: 11/24/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


Home