MEDICARE: PHYHEALTH SLEEP CARE CORPORATION

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	261QS1200X	Sleep Disorder Diagnostic Clinic/Center	20101632740	CO

General Provider Information

NPI Number	:	1437456076
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYHEALTH SLEEP CARE CORPORATION

Provider Business Mailing Address
First Line	:	1325 DRY CREEK DR
Second Line	:	SUITE #303
City	:	LONGMONT
State	:	CO
Zip	:	80503-7731
Country	:	US
Telephone Number	:	720-684-6167
Fax Number	:	303-684-6059

Provider Business Practice Location Address
First Line	:	1325 DRY CREEK DR
Second Line	:	SUITE #303
City	:	LONGMONT
State	:	CO
Zip	:	80503-7731
Country	:	US
Telephone Number	:	720-684-6167
Fax Number	:	303-684-6059

Authorized Official
Title or Position	:	CONSULTANT
Name	:	MS. CAROLYN KAY STANLEY
Credential	:
Telephone Number	:	303-659-5800

Provider Enumeration Date	:	02/17/2011
Last Update Date	:	03/08/2011

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