MEDICARE: PREMIER RIDES 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	:	1427783240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER RIDES LLC

Provider Business Mailing Address
First Line	:	12412 VISION CT
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72117-8011
Country	:	US
Telephone Number	:	501-266-3613
Fax Number	:

Provider Business Practice Location Address
First Line	:	12412 VISION CT
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72117-8011
Country	:	US
Telephone Number	:	501-266-3613
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BYRON E JACKSON
Credential	:
Telephone Number	:	501-266-3613

Provider Enumeration Date	:	07/18/2022
Last Update Date	:	07/18/2022

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