Healthcare Provider Details

I. General information

NPI: 1043104318
Provider Name (Legal Business Name): MDRIDES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 06/03/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8431 RADIO LANE
TAMPA FL
33619
US

IV. Provider business mailing address

9225 BAY PLAZA BLVD STE 417
TAMPA FL
33619-4412
US

V. Phone/Fax

Practice location:
  • Phone: 813-475-2596
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: MR. HEGEL BOSS
Title or Position: COO
Credential: MBA
Phone: 813-475-2596