Provider Demographics
NPI:1124707013
Name:MEDICAL RIDE LLC
Entity type:Organization
Organization Name:MEDICAL RIDE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:FAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:MUKTAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-207-8796
Mailing Address - Street 1:PO BOX 200912
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-0912
Mailing Address - Country:US
Mailing Address - Phone:720-207-8796
Mailing Address - Fax:
Practice Address - Street 1:102 S TEJON ST STE 1100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-2253
Practice Address - Country:US
Practice Address - Phone:720-207-8796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)