MEDICARE: RENE KONGA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)	33252868	TX

General Provider Information

NPI Number	:	1083116735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENE KONGA

Provider Business Mailing Address
First Line	:	1841 GREENFIELD AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-1516
Country	:	US
Telephone Number	:	817-655-5673
Fax Number	:

Provider Business Practice Location Address
First Line	:	1841 GREENFIELD AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-1516
Country	:	US
Telephone Number	:	817-655-5673
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2018
Last Update Date	:	03/08/2018

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Directions to “ RENE KONGA ” Practice Location

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