=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235938762
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TELIYADU RIDE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2025
-----------------------------------------------------
Last Update Date | 03/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 685 CITADEL DR E STE 290-7
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80909-5314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-757-5577
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 225 N SABLE BLVD UNIT 10315
-----------------------------------------------------
City | AURORA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80011-0827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-728-5260
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | WENDEMAGEN THEODORE BENNETT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 505-728-5260
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343800000X
-----------------------------------------------------
Taxonomy Name | Secured Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------