Healthcare Provider Details

I. General information

NPI: 1073134821
Provider Name (Legal Business Name): IDRIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2020
Last Update Date: 05/04/2020
Certification Date: 05/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 PATTERSON RD
DAYTON OH
45419-4308
US

IV. Provider business mailing address

425 PATTERSON RD
DAYTON OH
45419-4308
US

V. Phone/Fax

Practice location:
  • Phone: 937-979-9044
  • Fax: 937-979-9009
Mailing address:
  • Phone: 937-979-9044
  • Fax: 937-979-9009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KARIM TALLOU
Title or Position: GENERAL MANAGER
Credential:
Phone: 937-979-9044