Provider Demographics
NPI:1427821693
Name:MEDCONVERGE, LLC
Entity type:Organization
Organization Name:MEDCONVERGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SIRISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOMMIREDDIPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:CPC, COC
Authorized Official - Phone:470-398-0880
Mailing Address - Street 1:1901 N ROSELLE RD # 837
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60195-3176
Mailing Address - Country:US
Mailing Address - Phone:470-398-0880
Mailing Address - Fax:
Practice Address - Street 1:1901 N ROSELLE RD # 837
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60195-3176
Practice Address - Country:US
Practice Address - Phone:470-398-0880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty