Provider Demographics
NPI:1952696700
Name:EV RIDER, LLC
Entity Type:Organization
Organization Name:EV RIDER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-278-5054
Mailing Address - Street 1:6410 ARC WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-1357
Mailing Address - Country:US
Mailing Address - Phone:239-278-5054
Mailing Address - Fax:239-278-1431
Practice Address - Street 1:6410 ARC WAY
Practice Address - Street 2:SUITE A
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-1357
Practice Address - Country:US
Practice Address - Phone:239-278-5054
Practice Address - Fax:239-278-1431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies