Provider Demographics
NPI:1639181456
Name:TRICORE WEST, LLC
Entity Type:Organization
Organization Name:TRICORE WEST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:ZANG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:702-838-8558
Mailing Address - Street 1:8685 QUEENS BROOK CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-2229
Mailing Address - Country:US
Mailing Address - Phone:702-838-8558
Mailing Address - Fax:702-873-6880
Practice Address - Street 1:8685 QUEENS BROOK CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-2229
Practice Address - Country:US
Practice Address - Phone:702-838-8558
Practice Address - Fax:702-873-6880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9906213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty