MEDICARE: TWISTED GIZZARD ENTERPRISES 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	302R00000X	Health Maintenance Organization

General Provider Information

NPI Number	:	1154936334
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TWISTED GIZZARD ENTERPRISES LLC

Provider Business Mailing Address
First Line	:	8951 W SAHARA AVE STE 190
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-5899
Country	:	US
Telephone Number	:	702-685-1542
Fax Number	:

Provider Business Practice Location Address
First Line	:	8951 W SAHARA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-5898
Country	:	US
Telephone Number	:	702-685-1542
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JOSEPH INDRIERI
Credential	:	MSPT
Telephone Number	:	702-808-4943

Provider Enumeration Date	:	09/14/2020
Last Update Date	:	09/14/2020

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Directions to “TWISTED GIZZARD ENTERPRISES LLC ” Practice Location

Language	Start Address	Practice Location

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