MEDICARE: MRS. MARY ELIZABETH PHILLIPS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	247100000X	Radiologic Technologist	283037	NV
2	2471M2300X	Mammography Radiologic Technologist	283037	NV
3	2471S1302X	Sonography Radiologic Technologist

General Provider Information

NPI Number	:	1003089244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY ELIZABETH PHILLIPS

Provider Business Mailing Address
First Line	:	5319 EEL RIVER CT
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-3504
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5319 EEL RIVER CT
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-3504
Country	:	US
Telephone Number	:	702-994-1459
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2008
Last Update Date	:	04/09/2008

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