MEDICARE: RIDE EXPRESS 1

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)	343900000X	IN

General Provider Information

NPI Number	:	1275762296
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIDE EXPRESS 1

Provider Business Mailing Address
First Line	:	1817 BLACK BEAR DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46808-3512
Country	:	US
Telephone Number	:	260-348-1838
Fax Number	:	260-459-1782

Provider Business Practice Location Address
First Line	:	1817 BLACK BEAR DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46808-3512
Country	:	US
Telephone Number	:	260-348-1838
Fax Number	:	260-459-1782

Authorized Official
Title or Position	:	OWNER
Name	:	MARK A MUHAMMAD
Credential	:
Telephone Number	:	260-348-1838

Provider Enumeration Date	:	07/12/2009
Last Update Date	:	07/12/2009

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Directions to “RIDE EXPRESS 1 ” Practice Location

Language	Start Address	Practice Location

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