Provider Demographics
NPI:1902638893
Name:MEDI-CONNECT
Entity type:Organization
Organization Name:MEDI-CONNECT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:LIDALE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-254-0547
Mailing Address - Street 1:1558 STEPHANIE RD SE STE 104
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1560
Mailing Address - Country:US
Mailing Address - Phone:505-477-4714
Mailing Address - Fax:
Practice Address - Street 1:1558 STEPHANIE RD SE STE 104
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1560
Practice Address - Country:US
Practice Address - Phone:505-477-4714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-19
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No251B00000XAgenciesCase Management
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies