MEDICARE: RIDER MOBILITY INC.

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	332BC3200X	Customized Equipment (DME)
2	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1174094163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIDER MOBILITY INC.

Provider Business Mailing Address
First Line	:	3985 W CHEYENNE AVE STE 306
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-8907
Country	:	US
Telephone Number	:	702-272-0230
Fax Number	:	866-836-8782

Provider Business Practice Location Address
First Line	:	3985 W CHEYENNE AVE STE 306
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-8907
Country	:	US
Telephone Number	:	702-272-0230
Fax Number	:	866-836-8782

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KIRSTEN ALLISON WENDER
Credential	:	ATP
Telephone Number	:	702-445-2675

Provider Enumeration Date	:	12/17/2018
Last Update Date	:	02/23/2022

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