=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073759445
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VERGE TWO INTERNATIONAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2009
-----------------------------------------------------
Last Update Date | 01/06/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1613 MONTE CARLO DR
-----------------------------------------------------
City | MANSFIELD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76063-6292
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-473-7091
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1613 MONTE CARLO DR
-----------------------------------------------------
City | MANSFIELD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76063-6292
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | EMMANUEL ADUAYI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 240-432-8129
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | NON
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------