Provider Demographics
NPI:1184687519
Name:MEDI-RIDE, INC.
Entity Type:Organization
Organization Name:MEDI-RIDE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-883-6500
Mailing Address - Street 1:PO BOX 311
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IN
Mailing Address - Zip Code:47167-0311
Mailing Address - Country:US
Mailing Address - Phone:812-883-6500
Mailing Address - Fax:812-896-1900
Practice Address - Street 1:1414 W MULBERRY ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IN
Practice Address - Zip Code:47167-9434
Practice Address - Country:US
Practice Address - Phone:812-883-6500
Practice Address - Fax:812-896-1900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-07
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN529853343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100095030 AMedicaid