MEDICARE: PHI HEALTH, LLC

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	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center

General Provider Information

NPI Number	:	1568721553
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHI HEALTH, LLC

Provider Business Mailing Address
First Line	:	2405 E GRAND AVE
Second Line	:	SUITE D, BOX 136
City	:	LARAMIE
State	:	WY
Zip	:	82070-5206
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2405 E GRAND AVE
Second Line	:	SUITE D, BOX 136
City	:	LARAMIE
State	:	WY
Zip	:	82070-5206
Country	:	US
Telephone Number	:	214-244-9820
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DAVID W. TAYCE
Credential	:
Telephone Number	:	214-244-9820

Provider Enumeration Date	:	05/10/2012
Last Update Date	:	05/10/2012

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