MEDICARE: RED ROAD VENTURES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251K00000X	Public Health or Welfare Agency

General Provider Information

NPI Number	:	1114625357
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RED ROAD VENTURES LLC

Provider Business Mailing Address
First Line	:	5454 LEONE DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46226-1748
Country	:	US
Telephone Number	:	317-626-4387
Fax Number	:

Provider Business Practice Location Address
First Line	:	5454 LEONE DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46226-1748
Country	:	US
Telephone Number	:	317-626-4387
Fax Number	:

Authorized Official
Title or Position	:	CEO/FOUNDER
Name	:	JOHN MARTIN DICKERSON
Credential	:
Telephone Number	:	317-626-4387

Provider Enumeration Date	:	02/17/2023
Last Update Date	:	02/17/2023

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Directions to “RED ROAD VENTURES LLC ” Practice Location

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