Healthcare Provider Details

I. General information

NPI: 1053842120
Provider Name (Legal Business Name): RIDEY TAXI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4309 N 19TH ST #207
BISMARCK ND
58503-5688
US

IV. Provider business mailing address

4309 N 19TH ST P.O.BOX 574
BISMARCK ND
58503-5688
US

V. Phone/Fax

Practice location:
  • Phone: 701-214-5661
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY ALFA
Title or Position: DIRECTOR
Credential:
Phone: 701-214-5661