MEDICARE: ARIZONA STATE UROLOGY 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	208800000X	Urology Physician

General Provider Information

NPI Number	:	1508427667
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARIZONA STATE UROLOGY LLC

Provider Business Mailing Address
First Line	:	6525 W SACK DR STE 201
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-7106
Country	:	US
Telephone Number	:	602-337-8500
Fax Number	:	602-337-8151

Provider Business Practice Location Address
First Line	:	6525 W SACK DR STE 201
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-7106
Country	:	US
Telephone Number	:	602-337-8500
Fax Number	:	602-337-8151

Authorized Official
Title or Position	:	OWNER
Name	:	HOWARD P TAY
Credential	:
Telephone Number	:	602-337-8500

Provider Enumeration Date	:	06/27/2019
Last Update Date	:	01/13/2026

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Directions to “ARIZONA STATE UROLOGY LLC ” Practice Location

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