Provider Demographics
NPI:1396214896
Name:MEDRIDE LLC
Entity Type:Organization
Organization Name:MEDRIDE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARACICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-398-9593
Mailing Address - Street 1:5327 COMMERCIAL WAY STE D122
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-1420
Mailing Address - Country:US
Mailing Address - Phone:352-684-8000
Mailing Address - Fax:352-688-1025
Practice Address - Street 1:5327 COMMERCIAL WAY STE D122
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-1420
Practice Address - Country:US
Practice Address - Phone:352-398-9593
Practice Address - Fax:352-688-1025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)