Healthcare Provider Details

I. General information

NPI: 1235897976
Provider Name (Legal Business Name): EASY RYDE TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2021
Last Update Date: 01/24/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6443 FAIRMONT PKWY STE 140
PASADENA TX
77505-4359
US

IV. Provider business mailing address

6443 FAIRMONT PKWY STE 140
PASADENA TX
77505-4359
US

V. Phone/Fax

Practice location:
  • Phone: 832-926-9484
  • Fax:
Mailing address:
  • Phone: 832-926-9484
  • 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: MUSTAFA ADAM HAZAM
Title or Position: GENERAL MANAGER
Credential:
Phone: 832-926-9484