Provider Demographics
NPI:1689613572
Name:CHEYENNE MRI LLC
Entity Type:Organization
Organization Name:CHEYENNE MRI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HAID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-634-7711
Mailing Address - Street 1:2003 BLUEGRASS CIR
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-7329
Mailing Address - Country:US
Mailing Address - Phone:307-634-7711
Mailing Address - Fax:307-634-4167
Practice Address - Street 1:2003 BLUEGRASS CIR
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-7329
Practice Address - Country:US
Practice Address - Phone:307-634-7711
Practice Address - Fax:307-634-4167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO94005212Medicaid
WY106217401Medicaid
CO94005212Medicaid
CO94005212Medicaid
WY106217401Medicaid