MEDICARE: TAG 2 COLLABORATION

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1245720010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAG 2 COLLABORATION

Provider Business Mailing Address
First Line	:	5860 WYNN RD STE B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-3063
Country	:	US
Telephone Number	:	732-702-2300
Fax Number	:

Provider Business Practice Location Address
First Line	:	5860 WYNN RD STE B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-3063
Country	:	US
Telephone Number	:	732-702-2300
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JESSE MADER
Credential	:
Telephone Number	:	732-702-2300

Provider Enumeration Date	:	05/16/2018
Last Update Date	:	03/17/2026

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