Provider Demographics
NPI:1801510102
Name:MEDRIDE TRANS LLC
Entity type:Organization
Organization Name:MEDRIDE TRANS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEDIJA
Authorized Official - Middle Name:
Authorized Official - Last Name:NURU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-554-1745
Mailing Address - Street 1:1733 ARIAL DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-7340
Mailing Address - Country:US
Mailing Address - Phone:512-554-1745
Mailing Address - Fax:
Practice Address - Street 1:1733 ARIAL DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-7340
Practice Address - Country:US
Practice Address - Phone:512-554-1745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)