Convergent Integration Corporation

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

CONVERGENT INTEGRATION CORPORATION

Practice address

8508 Park Rd # 135
Charlotte, NC 28210-5803

Phone

(704) 516-5922

Fax

(704) 644-3828

NPI assigned

Feb 16, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Trevor Douglas Petruk

Title

President

Phone

(704) 516-5922

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1679617674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8508 PARK RD # 135",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282105803",
            "telephone_number": "704-516-5922",
            "fax_number": "704-644-3828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8508 PARK RD # 135",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282105803",
            "telephone_number": "704-516-5922",
            "fax_number": "704-644-3828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONVERGENT INTEGRATION CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PETRUK",
        "authorized_official_first_name": "TREVOR",
        "authorized_official_middle_name": "DOUGLAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "704-516-5922",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.