Provider Demographics
NPI:1841049574
Name:MEDI-DRIVE, LLC
Entity type:Organization
Organization Name:MEDI-DRIVE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:GOLDEN
Authorized Official - Middle Name:JAROM
Authorized Official - Last Name:OMLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-306-4176
Mailing Address - Street 1:9109 120TH STREET CT E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-7907
Mailing Address - Country:US
Mailing Address - Phone:253-306-4173
Mailing Address - Fax:
Practice Address - Street 1:15406 MERIDIAN E STE 206
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-9504
Practice Address - Country:US
Practice Address - Phone:253-306-4173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)