MEDICARE: HEALTHYU PHOENIX THOMAS ROAD

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	332900000X	Non-Pharmacy Dispensing Site

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073229191
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHYU PHOENIX THOMAS ROAD

Provider Business Mailing Address
First Line	:	840 E MCKELLIPS RD STE 105
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85203-9654
Country	:	US
Telephone Number	:	602-491-0703
Fax Number	:

Provider Business Practice Location Address
First Line	:	7910 W THOMAS RD STE 112
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85033-4830
Country	:	US
Telephone Number	:	602-491-0703
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SHANE SPEIRS
Credential	:	MD
Telephone Number	:	480-495-5485

Provider Enumeration Date	:	01/24/2023
Last Update Date	:	01/24/2023

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