Provider Demographics
NPI:1609001460
Name:CONVERGE DIAGNOSTIC SERVICES LLC
Entity Type:Organization
Organization Name:CONVERGE DIAGNOSTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DOUGREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-548-5202
Mailing Address - Street 1:200 CORPORATE PL
Mailing Address - Street 2:SUITE 7
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-3840
Mailing Address - Country:US
Mailing Address - Phone:978-535-1344
Mailing Address - Fax:978-535-1934
Practice Address - Street 1:200 CORPORATE PL
Practice Address - Street 2:SUITE 7
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-3840
Practice Address - Country:US
Practice Address - Phone:978-535-1344
Practice Address - Fax:978-535-1934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-22
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory