Provider Demographics
NPI:1932468931
Name:GUARDIAN ANGEL ANESTHESIA SERVICES LTD
Entity Type:Organization
Organization Name:GUARDIAN ANGEL ANESTHESIA SERVICES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLAY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:573-686-5550
Mailing Address - Street 1:1081 RIVER TER
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-3417
Mailing Address - Country:US
Mailing Address - Phone:573-686-5550
Mailing Address - Fax:
Practice Address - Street 1:600 N UNION AVE
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-4194
Practice Address - Country:US
Practice Address - Phone:573-686-5550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-10
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX314879301Medicaid
TX1932468931OtherTX BCBS
TXTXB154654Medicare PIN