Healthcare Provider Details

I. General information

NPI: 1841962289
Provider Name (Legal Business Name): TRICORE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 10/15/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 WOODWARD PL NE
ALBUQUERQUE NM
87102-2705
US

IV. Provider business mailing address

1001 WOODWARD PL NE
ALBUQUERQUE NM
87102-2705
US

V. Phone/Fax

Practice location:
  • Phone: 505-938-8888
  • Fax: 505-938-8833
Mailing address:
  • Phone: 505-938-8888
  • Fax: 505-938-8833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MS. ELLA WATT
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 505-573-4288