MEDICARE: MY RIDE TRANSPORTATION, LLC

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	:	1255100095
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY RIDE TRANSPORTATION, LLC

Provider Business Mailing Address
First Line	:	5706 NODLEHS CT
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46221-4855
Country	:	US
Telephone Number	:	317-400-2856
Fax Number	:

Provider Business Practice Location Address
First Line	:	5706 NODLEHS CT
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46221-4855
Country	:	US
Telephone Number	:	317-400-2856
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. KEVIN VERBURG
Credential	:
Telephone Number	:	317-400-2856

Provider Enumeration Date	:	12/21/2023
Last Update Date	:	12/21/2023

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