MEDICARE: RED E 2 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	:	1760014609
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RED E 2 RIDE LLC

Provider Business Mailing Address
First Line	:	410 OLD JACKSON HWY
Second Line	:
City	:	LORETTO
State	:	TN
Zip	:	38469-3204
Country	:	US
Telephone Number	:	931-853-4669
Fax Number	:

Provider Business Practice Location Address
First Line	:	410 OLD JACKSON HWY
Second Line	:
City	:	LORETTO
State	:	TN
Zip	:	38469-3204
Country	:	US
Telephone Number	:	931-853-4669
Fax Number	:

Authorized Official
Title or Position	:	MANAGER/MEMBER
Name	:	BECKY ALLEN
Credential	:
Telephone Number	:	931-629-9806

Provider Enumeration Date	:	02/09/2020
Last Update Date	:	02/09/2020

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Directions to “RED E 2 RIDE LLC ” Practice Location

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