Provider Demographics
NPI:1225749666
Name:EAGLE RIDE TRANSPORTATION LLC
Entity Type:Organization
Organization Name:EAGLE RIDE TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:EYOB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-602-1572
Mailing Address - Street 1:3421 HIGH PLATEAU DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-5880
Mailing Address - Country:US
Mailing Address - Phone:469-602-1572
Mailing Address - Fax:
Practice Address - Street 1:3421 HIGH PLATEAU DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-5880
Practice Address - Country:US
Practice Address - Phone:469-602-1572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-06
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No343800000XTransportation ServicesSecured Medical Transport (VAN)