Healthcare Provider Details

I. General information

NPI: 1548392046
Provider Name (Legal Business Name): RICK WILSON MEDIRIDE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2007
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 1 BOX 234B
CANEY KS
67333-9691
US

IV. Provider business mailing address

RR 1 BOX 234B
CANEY KS
67333-9691
US

V. Phone/Fax

Practice location:
  • Phone: 620-289-4616
  • Fax:
Mailing address:
  • Phone: 620-289-4616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347B00000X
TaxonomyBus
License NumberXLM488
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberXBX214
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberWXZ714
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberWQO283
License Number StateKS
# 5
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberXLM675
License Number StateKS
# 6
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberUMV953
License Number StateKS
# 7
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberVFJ718
License Number StateKS
# 8
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberVKD486
License Number StateKS
# 9
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number61510
License Number StateKS
# 10
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: RICK D WILSON
Title or Position: OWNER-OPERATOR
Credential:
Phone: 620-289-4616