MEDICARE: PRODIGY MEDRIDE 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	:	1578495081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRODIGY MEDRIDE LLC

Provider Business Mailing Address
First Line	:	4715 HIGH POINT LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77053-1213
Country	:	US
Telephone Number	:	832-215-0124
Fax Number	:

Provider Business Practice Location Address
First Line	:	4715 HIGH POINT LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77053-1213
Country	:	US
Telephone Number	:	832-215-0124
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	COREY LYNDELL BLOUNT JR.
Credential	:
Telephone Number	:	832-215-0124

Provider Enumeration Date	:	05/30/2026
Last Update Date	:	05/30/2026

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