Provider Demographics
NPI:1124549308
Name:MEDI - RIDES TRANSPORT LLC
Entity Type:Organization
Organization Name:MEDI - RIDES TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:334-478-3857
Mailing Address - Street 1:PO BOX 780865
Mailing Address - Street 2:
Mailing Address - City:TALLASSEE
Mailing Address - State:AL
Mailing Address - Zip Code:36078-0009
Mailing Address - Country:US
Mailing Address - Phone:334-478-3857
Mailing Address - Fax:334-478-7018
Practice Address - Street 1:173 HILL STREET
Practice Address - Street 2:SUITE 103
Practice Address - City:WETUMPKA
Practice Address - State:AL
Practice Address - Zip Code:36092
Practice Address - Country:US
Practice Address - Phone:334-478-3857
Practice Address - Fax:334-478-7018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-28
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)