MEDICARE: RIDER MOBILITY INC.

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	332BC3200X	Customized Equipment (DME)
2	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1578165734
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIDER MOBILITY INC.

Provider Business Mailing Address
First Line	:	3985 W CHEYENNE AVE STE 306
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-8907
Country	:	US
Telephone Number	:	702-272-0230
Fax Number	:	702-272-0289

Provider Business Practice Location Address
First Line	:	5735 KEARNY VILLA RD STE 111
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1138
Country	:	US
Telephone Number	:	858-598-5505
Fax Number	:	858-598-5508

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KIRSTEN WENDER
Credential	:	ATP
Telephone Number	:	702-272-0230

Provider Enumeration Date	:	11/12/2020
Last Update Date	:	03/08/2024

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