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General NPI Number Information
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NPI Number | 1679380109
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Entity Type | Organization
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Legal Business Name | JEWELRIDE LLC
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Dates
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Enumeration Date | 12/17/2024
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 2110 TROY RD STE G
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City | EDWARDSVILLE
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State | IL
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Zip | 62025-2549
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Country | US
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Telephone | 618-250-4771
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Fax |
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Provider Business Mailing Address
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Address Line | 2110 TROY RD STE G
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City | EDWARDSVILLE
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State | IL
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Zip | 62025-2549
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-FOUNDER AND CEO
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Name | TAPIWA MUPEREKI
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Credential |
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Telephone | 618-917-7372
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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