MEDICARE: OMNI 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	:	1528823846
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OMNI RIDE LLC

Provider Business Mailing Address
First Line	:	7336 JANE PARKS WAY
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28217-3673
Country	:	US
Telephone Number	:	910-364-4200
Fax Number	:

Provider Business Practice Location Address
First Line	:	7670 RAEFORD RD
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-5916
Country	:	US
Telephone Number	:	910-676-4832
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	TERRI A MARTIN
Credential	:
Telephone Number	:	910-364-4200

Provider Enumeration Date	:	02/15/2024
Last Update Date	:	02/15/2024

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Directions to “OMNI RIDE LLC ” Practice Location

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