Provider Demographics
NPI:1962283309
Name:MED RIDE TRANSPORT LLC
Entity type:Organization
Organization Name:MED RIDE TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FAHED
Authorized Official - Middle Name:KAMAL
Authorized Official - Last Name:IKBARIEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-431-1684
Mailing Address - Street 1:15 WIND TREE CV
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2974
Mailing Address - Country:US
Mailing Address - Phone:731-431-1684
Mailing Address - Fax:
Practice Address - Street 1:21 OLD HICKORY BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305
Practice Address - Country:US
Practice Address - Phone:731-431-1684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-11
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)