MEDICARE: IDRIVE LLC

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)

General Provider Information

NPI Number	:	1073134821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IDRIVE LLC

Provider Business Mailing Address
First Line	:	425 PATTERSON RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45419-4308
Country	:	US
Telephone Number	:	937-979-9044
Fax Number	:	937-979-9009

Provider Business Practice Location Address
First Line	:	425 PATTERSON RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45419-4308
Country	:	US
Telephone Number	:	937-979-9044
Fax Number	:	937-979-9009

Authorized Official
Title or Position	:	GENERAL MANAGER
Name	:	KARIM TALLOU
Credential	:
Telephone Number	:	937-979-9044

Provider Enumeration Date	:	05/04/2020
Last Update Date	:	05/04/2020

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Directions to “IDRIVE LLC ” Practice Location

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