MEDICARE: QUICKRIDE 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)	951343	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508135765
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUICKRIDE LLC

Provider Business Mailing Address
First Line	:	2701 WESLEYAN DR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-3771
Country	:	US
Telephone Number	:	907-250-5902
Fax Number	:	907-338-0423

Provider Business Practice Location Address
First Line	:	2701 WESLEYAN DR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-3771
Country	:	US
Telephone Number	:	907-250-5902
Fax Number	:	907-338-0423

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ROBERT FIDEL PENTECOSTES
Credential	:
Telephone Number	:	907-250-5902

Provider Enumeration Date	:	12/16/2011
Last Update Date	:	12/16/2011

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Directions to “QUICKRIDE LLC ” Practice Location

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