Provider Demographics
NPI:1912077587
Name:GUARDIAN HEALTH SYSTEMS VERNON
Entity Type:Organization
Organization Name:GUARDIAN HEALTH SYSTEMS VERNON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:TOBEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:405-848-0338
Mailing Address - Street 1:2508 OAKLAWN AVENUE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219
Mailing Address - Country:US
Mailing Address - Phone:405-848-0338
Mailing Address - Fax:405-848-0351
Practice Address - Street 1:1720 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:TX
Practice Address - Zip Code:76384-4099
Practice Address - Country:US
Practice Address - Phone:405-848-0338
Practice Address - Fax:405-848-0351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX168323336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX750696OtherBCBS TX