Provider Demographics
NPI:1407339070
Name:CONVERGE MEDICAL TECHNOLOGY, LLC
Entity Type:Organization
Organization Name:CONVERGE MEDICAL TECHNOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:CORTEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-671-1189
Mailing Address - Street 1:14707 FITZHUGH RD # D-200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78736-6313
Mailing Address - Country:US
Mailing Address - Phone:800-765-8643
Mailing Address - Fax:
Practice Address - Street 1:14707 FITZHUGH RD # D-200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78736-6313
Practice Address - Country:US
Practice Address - Phone:800-765-8643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-10
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1002281OtherTEXAS MANUFACATURER DME LICENCIE