=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871452912
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MISSION RIDES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2026
-----------------------------------------------------
Last Update Date | 01/15/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 63 N 100 W
-----------------------------------------------------
City | PIMA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85543-9845
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-208-7717
-----------------------------------------------------
Fax | 206-691-8689
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2030 W BASELINE RD # 182-1551
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85041-6574
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-208-7717
-----------------------------------------------------
Fax | 206-691-8689
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPERATIONS DIRECTOR
-----------------------------------------------------
Name | JUSTIN BERGENER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 509-307-7365
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------