Provider Demographics
NPI:1669120598
Name:RIDGE RUNNNERS 365 LLC
Entity type:Organization
Organization Name:RIDGE RUNNNERS 365 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:VAUGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-284-1516
Mailing Address - Street 1:740 DRY RD
Mailing Address - Street 2:
Mailing Address - City:SPEEDWELL
Mailing Address - State:VA
Mailing Address - Zip Code:24374-3617
Mailing Address - Country:US
Mailing Address - Phone:276-284-1516
Mailing Address - Fax:
Practice Address - Street 1:740 DRY RD
Practice Address - Street 2:
Practice Address - City:SPEEDWELL
Practice Address - State:VA
Practice Address - Zip Code:24374-3617
Practice Address - Country:US
Practice Address - Phone:276-284-1516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-10
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)