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	:	1629623137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MED-RIDE LLC

Provider Business Mailing Address
First Line	:	1130 N WAYNE ST APT C
Second Line	:
City	:	MILLEDGEVILLE
State	:	GA
Zip	:	31061-7535
Country	:	US
Telephone Number	:	678-221-7654
Fax Number	:

Provider Business Practice Location Address
First Line	:	1130 N WAYNE ST APT C
Second Line	:
City	:	MILLEDGEVILLE
State	:	GA
Zip	:	31061-7535
Country	:	US
Telephone Number	:	678-221-7654
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	MR. JOHN WALTER HARDEN
Credential	:
Telephone Number	:	678-221-7565

Provider Enumeration Date	:	08/02/2019
Last Update Date	:	05/30/2024

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Directions to “MED-RIDE LLC ” Practice Location

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