MEDICARE: VITALRIDE 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	:	1811813967
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITALRIDE MEDICAL TRANSPORT LLC

Provider Business Mailing Address
First Line	:	12610 SW 72ND TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-3535
Country	:	US
Telephone Number	:	305-439-4877
Fax Number	:

Provider Business Practice Location Address
First Line	:	375 W 22ND ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-1444
Country	:	US
Telephone Number	:	305-439-4877
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MIRELYS VALDES
Credential	:
Telephone Number	:	305-439-4877

Provider Enumeration Date	:	06/24/2026
Last Update Date	:	06/24/2026

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