Provider Demographics
NPI:1053782490
Name:AZURE RIDE
Entity type:Organization
Organization Name:AZURE RIDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JONES
Authorized Official - Middle Name:
Authorized Official - Last Name:BITANGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-537-9333
Mailing Address - Street 1:6000 BASS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55429-2700
Mailing Address - Country:US
Mailing Address - Phone:763-537-9333
Mailing Address - Fax:
Practice Address - Street 1:6000 BASS LAKE RD
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55429-2700
Practice Address - Country:US
Practice Address - Phone:763-537-9333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4144OtherMEDICAL TRANSPORTATION