MEDICARE: GO RIDE LAKE CHARLES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1215885140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GO RIDE LAKE CHARLES

Provider Business Mailing Address
First Line	:	124 HEYMANN BLVD STE 107
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70503-2363
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 W 11TH ST # D8
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-6035
Country	:	US
Telephone Number	:	225-367-4065
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT & MANAGING MEMBER
Name	:	DAN REID
Credential	:
Telephone Number	:	601-544-5403

Provider Enumeration Date	:	03/17/2026
Last Update Date	:	03/17/2026

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Directions to “GO RIDE LAKE CHARLES ” Practice Location

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