Provider Demographics
NPI:1386450740
Name:MEDRIDE LLC
Entity type:Organization
Organization Name:MEDRIDE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOGTBA
Authorized Official - Middle Name:
Authorized Official - Last Name:MASHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-644-0488
Mailing Address - Street 1:2397 ALISON AVE
Mailing Address - Street 2:
Mailing Address - City:PINGREE GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60140-6456
Mailing Address - Country:US
Mailing Address - Phone:773-644-0488
Mailing Address - Fax:
Practice Address - Street 1:2397 ALISON AVE
Practice Address - Street 2:
Practice Address - City:PINGREE GROVE
Practice Address - State:IL
Practice Address - Zip Code:60140-6456
Practice Address - Country:US
Practice Address - Phone:773-644-0488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)