Provider Demographics
NPI:1548392046
Name:RICK WILSON MEDIRIDE
Entity Type:Organization
Organization Name:RICK WILSON MEDIRIDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-289-4616
Mailing Address - Street 1:RR 1 BOX 234B
Mailing Address - Street 2:
Mailing Address - City:CANEY
Mailing Address - State:KS
Mailing Address - Zip Code:67333-9691
Mailing Address - Country:US
Mailing Address - Phone:620-289-4616
Mailing Address - Fax:
Practice Address - Street 1:RR 1 BOX 234B
Practice Address - Street 2:
Practice Address - City:CANEY
Practice Address - State:KS
Practice Address - Zip Code:67333-9691
Practice Address - Country:US
Practice Address - Phone:620-289-4616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-10
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSXLM488347B00000X
KSXBX214347C00000X
KSWXZ714347C00000X
KSWQO283347C00000X
KSXLM675347C00000X
KSUMV953347C00000X
KSVFJ718347C00000X
KSVKD486347C00000X
KS61510347C00000X
347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No347B00000XTransportation ServicesBus
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100420430AMedicaid