Provider Demographics
NPI:1073134821
Name:IDRIVE LLC
Entity Type:Organization
Organization Name:IDRIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KARIM
Authorized Official - Middle Name:
Authorized Official - Last Name:TALLOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-979-9044
Mailing Address - Street 1:425 PATTERSON RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45419-4308
Mailing Address - Country:US
Mailing Address - Phone:937-979-9044
Mailing Address - Fax:937-979-9009
Practice Address - Street 1:425 PATTERSON RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45419-4308
Practice Address - Country:US
Practice Address - Phone:937-979-9044
Practice Address - Fax:937-979-9009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-04
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)