MEDICARE: MDRIDES, 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	253Z00000X	In Home Supportive Care Agency
2	343900000X	Non-emergency Medical Transport (VAN)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790211290
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MDRIDES, LLC

Provider Business Mailing Address
First Line	:	8431 RADIO LN
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-1319
Country	:	US
Telephone Number	:	813-540-8632
Fax Number	:	813-381-7719

Provider Business Practice Location Address
First Line	:	8431 RADIO LN
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-1319
Country	:	US
Telephone Number	:	813-475-2596
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	HEGEL BOSS
Credential	:
Telephone Number	:	813-475-2596

Provider Enumeration Date	:	05/04/2017
Last Update Date	:	05/22/2025

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Directions to “MDRIDES, LLC ” Practice Location

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