MEDICARE: MEDRIDE MEDICAL TRANSPORT 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	:	1427909431
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDRIDE MEDICAL TRANSPORT LLC

Provider Business Mailing Address
First Line	:	223 ROLLING FORK BND
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75039-3809
Country	:	US
Telephone Number	:	972-854-2323
Fax Number	:

Provider Business Practice Location Address
First Line	:	223 ROLLING FORK BND
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75039-3809
Country	:	US
Telephone Number	:	972-854-2323
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	IFEATU AZUKA ONUBOGU
Credential	:
Telephone Number	:	469-403-7099

Provider Enumeration Date	:	02/05/2026
Last Update Date	:	02/05/2026

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