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General NPI Number Information
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NPI Number | 1780479980
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Entity Type | Organization
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Legal Business Name | MEDIRIDE LLC
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Dates
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Enumeration Date | 04/10/2025
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 11230 LANEWOOD CIR
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-4029
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Country | US
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Telephone | 507-594-8073
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Fax |
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Provider Business Mailing Address
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Address Line | 8500 NORMANDALE LAKE BLVD STE 350
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City | BLOOMINGTON
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State | MN
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Zip | 55437-3805
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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 | CEO/MANAGER
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Name | MR. LIBAN OSMAN
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Credential |
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Telephone | 507-594-8073
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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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