Provider Demographics
NPI:1124867031
Name:BOOMERRIDE LLC
Entity type:Organization
Organization Name:BOOMERRIDE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-701-1547
Mailing Address - Street 1:2233 W LINDSEY ST STE 117
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-4067
Mailing Address - Country:US
Mailing Address - Phone:405-551-8811
Mailing Address - Fax:
Practice Address - Street 1:2233 W LINDSEY ST STE 117
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-4067
Practice Address - Country:US
Practice Address - Phone:405-551-8811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi