Provider Demographics
NPI:1316243058
Name:CONVERTABATH, INC.
Entity type:Organization
Organization Name:CONVERTABATH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEANNINE
Authorized Official - Middle Name:S
Authorized Official - Last Name:DINGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-656-1348
Mailing Address - Street 1:1605 W UNIVERSITY DR
Mailing Address - Street 2:SUITE 109
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-3267
Mailing Address - Country:US
Mailing Address - Phone:480-646-1348
Mailing Address - Fax:480-446-7015
Practice Address - Street 1:1605 W UNIVERSITY DR
Practice Address - Street 2:SUITE 109
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-3267
Practice Address - Country:US
Practice Address - Phone:480-646-1348
Practice Address - Fax:480-446-7015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ259082332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ20096376OtherSTATE RESALE BUSINESS LICENSE
AZ259082OtherARIZONA REGISTRAR OF CONTRACTORS LICENSE