Provider Demographics
NPI:1982319364
Name:AYOMIDE LLC
Entity Type:Organization
Organization Name:AYOMIDE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-332-3331
Mailing Address - Street 1:2 SANDY HILL DR
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-2320
Mailing Address - Country:US
Mailing Address - Phone:347-332-3331
Mailing Address - Fax:
Practice Address - Street 1:2 SANDY HILL DR
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-2320
Practice Address - Country:US
Practice Address - Phone:347-332-3331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)