Organization
IRENEE A. LEBUABANGA
Active
Other names
AMGC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. IRENEE ABONEGI LEBUABANGA (OWNER)
(817) 992-9138
Entity
Organization
Contact information
Practice address
2669 GRAND COLONIAL ST, GRAND PRAIRIE, TX 75054-0258
(817) 992-9138
(817) 404-4727
Mailing address
2669 GRAND COLONIAL ST, GRAND PRAIRIE, TX 75054-0258
(817) 992-9138
(817) 404-4727
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Enumeration date
08/24/2020
Last updated
08/27/2020
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