Provider Demographics
NPI:1497185227
Name:MEDURIDE LLC
Entity Type:Organization
Organization Name:MEDURIDE LLC
Other - Org Name:MEDRIDE4U
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUTHERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-810-0418
Mailing Address - Street 1:1314 W MCDERMOTT DR
Mailing Address - Street 2:SUITE 106-444
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-3021
Mailing Address - Country:US
Mailing Address - Phone:214-450-3073
Mailing Address - Fax:
Practice Address - Street 1:1314 W MCDERMOTT DR
Practice Address - Street 2:SUITE 106-444
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-3021
Practice Address - Country:US
Practice Address - Phone:214-450-3073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-14
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)