Provider Demographics
NPI:1013646264
Name:MENDS, EGERTON TAMBA
Entity type:Individual
Prefix:MR
First Name:EGERTON
Middle Name:TAMBA
Last Name:MENDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7149 VAN TUYL PKWY APT 20207
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-1255
Mailing Address - Country:US
Mailing Address - Phone:347-866-5850
Mailing Address - Fax:
Practice Address - Street 1:7149 VAN TUYL PKWY APT 20207
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070
Practice Address - Country:US
Practice Address - Phone:347-866-5850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-05
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY940870283172A00000X
48585475343900000X
TX48585475343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No172A00000XOther Service ProvidersDriver