MEDICARE: TRICORE WEST, 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	213E00000X	Podiatrist	9906	NV

General Provider Information

NPI Number	:	1639181456
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRICORE WEST, LLC

Provider Business Mailing Address
First Line	:	8685 QUEENS BROOK CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-2229
Country	:	US
Telephone Number	:	702-838-8558
Fax Number	:	702-873-6880

Provider Business Practice Location Address
First Line	:	8685 QUEENS BROOK CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-2229
Country	:	US
Telephone Number	:	702-838-8558
Fax Number	:	702-873-6880

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. TODD ZANG
Credential	:	DPM
Telephone Number	:	702-838-8558

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	08/22/2020

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Directions to “TRICORE WEST, LLC ” Practice Location

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