Healthcare Provider Details

I. General information

NPI: 1366267700
Provider Name (Legal Business Name): MED-RIDE LOGISTICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 WOODLAND SQUARE BLVD STE 250
CONROE TX
77384-2212
US

IV. Provider business mailing address

1222 CALLISTA AVE
VALRICO FL
33596-7001
US

V. Phone/Fax

Practice location:
  • Phone: 813-214-9720
  • Fax:
Mailing address:
  • Phone: 813-214-9720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: AMONGBA SALIFU HARUNA
Title or Position: OWNER
Credential:
Phone: 813-214-9720