Provider Demographics
NPI:1831654888
Name:SUPER RIDE LLC
Entity Type:Organization
Organization Name:SUPER RIDE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:M
Authorized Official - Last Name:SALEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-252-2277
Mailing Address - Street 1:1637 E LIVINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-3031
Mailing Address - Country:US
Mailing Address - Phone:614-252-2277
Mailing Address - Fax:614-258-8186
Practice Address - Street 1:1637 E LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-3031
Practice Address - Country:US
Practice Address - Phone:614-252-2277
Practice Address - Fax:614-258-8186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)