Provider Demographics
NPI:1780392647
Name:MYRIDE SC, LLC
Entity type:Organization
Organization Name:MYRIDE SC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:SWANNER
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:843-267-5455
Mailing Address - Street 1:3454 WACCAMAW DRIVE, UNIT C
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579
Mailing Address - Country:US
Mailing Address - Phone:843-236-0204
Mailing Address - Fax:866-729-6918
Practice Address - Street 1:3454 WACCAMAW DRIVE, UNIT C
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579
Practice Address - Country:US
Practice Address - Phone:843-236-0204
Practice Address - Fax:866-729-6918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)