Provider Demographics
NPI:1447291885
Name:GUARDIAN ANESTHESIA SERVICES & PAIN
Entity type:Organization
Organization Name:GUARDIAN ANESTHESIA SERVICES & PAIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAYASHREE
Authorized Official - Middle Name:N
Authorized Official - Last Name:GORREPATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-223-7878
Mailing Address - Street 1:4041 W WHEATLAND RD
Mailing Address - Street 2:156 343
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-4064
Mailing Address - Country:US
Mailing Address - Phone:972-223-7878
Mailing Address - Fax:972-283-0284
Practice Address - Street 1:1010 E WHEATLAND RD
Practice Address - Street 2:SUITE A
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-4914
Practice Address - Country:US
Practice Address - Phone:972-283-0063
Practice Address - Fax:972-283-0284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150480501Medicaid
TX00414TMedicare ID - Type Unspecified