MEDICARE: MED-RIDE 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	:	1316481914
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MED-RIDE LLC

Provider Business Mailing Address
First Line	:	3644 EARLE DR
Second Line	:
City	:	HALTOM CITY
State	:	TX
Zip	:	76117-3003
Country	:	US
Telephone Number	:	817-495-8456
Fax Number	:

Provider Business Practice Location Address
First Line	:	3644 EARLE DR
Second Line	:
City	:	HALTOM CITY
State	:	TX
Zip	:	76117-3003
Country	:	US
Telephone Number	:	817-495-8456
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RONNIE LEE HERRING
Credential	:
Telephone Number	:	817-495-8456

Provider Enumeration Date	:	12/15/2016
Last Update Date	:	12/15/2016

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Directions to “MED-RIDE LLC ” Practice Location

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