Individual ProviderTy PfauStudent in an Organized Health Care Education/Training ProgramStudent, Health CarePractice Address18701 N 67th Ave, Glendale, AZ 85308-7100(877) 934-9355PECOS EnrollmentBased on the most recent information from CMS, provider Ty Pfau is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 6 days ago.Profile DetailsProvider ID1154901742Provider TypeIndividualFull NamePfau, TyCredentialDOGenderMaleSole ProprietorYesEnumeration Date4/9/2021Last Updated6/6/2024Contact InformationPractice LocationPractice Address18701 N 67th Ave, Glendale, AZ 85308-7100Phone(877) 934-9355FaxUnlisted FaxMailing LocationMailing Address18701 N 67th Ave, Glendale, AZ 85308-7100Phone(877) 934-9355FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode390200000XPrimaryDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted IssuerCode208D00000XDescriptionGeneral PracticeAllopathic & Osteopathic PhysiciansLicense011065Arizona