Provider Demographics
NPI:1275762296
Name:RIDE EXPRESS 1
Entity Type:Organization
Organization Name:RIDE EXPRESS 1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:MUHAMMAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-348-1838
Mailing Address - Street 1:1817 BLACK BEAR DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46808-3512
Mailing Address - Country:US
Mailing Address - Phone:260-348-1838
Mailing Address - Fax:260-459-1782
Practice Address - Street 1:1817 BLACK BEAR DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46808-3512
Practice Address - Country:US
Practice Address - Phone:260-348-1838
Practice Address - Fax:260-459-1782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-12
Last Update Date:2009-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN343900000X343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)