Provider Demographics
NPI:1932098688
Name:RIDEWELL MEDICAL TRANSPORT LLC
Entity type:Organization
Organization Name:RIDEWELL MEDICAL TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:AL RIKABI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:629-237-0802
Mailing Address - Street 1:111 KASH CT
Mailing Address - Street 2:
Mailing Address - City:LA VERGNE
Mailing Address - State:TN
Mailing Address - Zip Code:37086-4212
Mailing Address - Country:US
Mailing Address - Phone:629-237-0802
Mailing Address - Fax:
Practice Address - Street 1:3104 AIDAN LN
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-8564
Practice Address - Country:US
Practice Address - Phone:629-237-0802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)