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General NPI Number Information
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NPI Number | 1912609462
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Entity Type | Organization
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Legal Business Name | YOUR RIDE TRANSPORT, LLC
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Dates
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Enumeration Date | 03/20/2023
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Last Update Date | 05/09/2023
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Provider Practice Location Address
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Address Line | 107 S GAINES ST STE 104
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City | ENNIS
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State | TX
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Zip | 75119-4612
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Country | US
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Telephone | 785-375-1221
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Fax | 972-875-6276
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Provider Business Mailing Address
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Address Line | PO BOX 1125
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City | ENNIS
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State | TX
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Zip | 75120-1125
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Country | US
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Telephone | 785-375-1221
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Fax | 972-875-6276
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Authorized Official
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Title or Position | OWNER
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Name | GREGORY DONALD NICKLES
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Credential |
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Telephone | 785-375-1221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343800000X
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Taxonomy Name | Secured Medical Transport (VAN)
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License Number |
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License Number State |
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