Provider Demographics
NPI:1952837437
Name:MEDI RIDE LLC
Entity Type:Organization
Organization Name:MEDI RIDE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TESS
Authorized Official - Middle Name:L
Authorized Official - Last Name:BEAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER OF COMPANY
Authorized Official - Phone:415-761-9259
Mailing Address - Street 1:926 A DIABLO AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-4025
Mailing Address - Country:US
Mailing Address - Phone:415-761-9259
Mailing Address - Fax:
Practice Address - Street 1:724 MCCLAY RD
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-3863
Practice Address - Country:US
Practice Address - Phone:415-761-9259
Practice Address - Fax:415-761-9259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-03
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)