MEDICARE: TYT PLLC

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	207LP2900X	Pain Medicine (Anesthesiology) Physician	1129382	AZ

General Provider Information

NPI Number	:	1417433863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TYT PLLC

Provider Business Mailing Address
First Line	:	24200 N ALMA SCHOOL RD UNIT 8
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85255-3001
Country	:	US
Telephone Number	:	480-818-8617
Fax Number	:

Provider Business Practice Location Address
First Line	:	3135 E LINCOLN DR STE B
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-2301
Country	:	US
Telephone Number	:	480-418-1626
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. PAULA S ROSE
Credential	:	CRNA
Telephone Number	:	480-818-8617

Provider Enumeration Date	:	07/18/2018
Last Update Date	:	07/18/2018

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