Provider Demographics
NPI:1063964864
Name:MED RIDE
Entity type:Organization
Organization Name:MED RIDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAMID
Authorized Official - Middle Name:K
Authorized Official - Last Name:EGHBAL
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:480-200-8177
Mailing Address - Street 1:10055 N 142ND ST UNIT 1130
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-5524
Mailing Address - Country:US
Mailing Address - Phone:480-200-8177
Mailing Address - Fax:
Practice Address - Street 1:10055 N. 142ND ST.# 1130
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259
Practice Address - Country:US
Practice Address - Phone:480-200-8177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ50174344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi