Provider Demographics
NPI:1154936334
Name:TWISTED GIZZARD ENTERPRISES LLC
Entity type:Organization
Organization Name:TWISTED GIZZARD ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:INDRIERI
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:702-808-4943
Mailing Address - Street 1:8951 W SAHARA AVE STE 190
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-5899
Mailing Address - Country:US
Mailing Address - Phone:702-685-1542
Mailing Address - Fax:
Practice Address - Street 1:8951 W SAHARA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-5898
Practice Address - Country:US
Practice Address - Phone:702-685-1542
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization