Provider Demographics
NPI:1295518918
Name:MIDWEST MEDICAL RIDES, LLC
Entity type:Organization
Organization Name:MIDWEST MEDICAL RIDES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KEELY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-302-4761
Mailing Address - Street 1:728 1ST AVE N STE 9
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-3804
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1253 N 25TH ST
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-2110
Practice Address - Country:US
Practice Address - Phone:515-302-4761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0124753Medicaid