MEDICARE: JASPEN TRANSPORT 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	172A00000X	Driver

General Provider Information

NPI Number	:	1346012218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JASPEN TRANSPORT LLC

Provider Business Mailing Address
First Line	:	2915 N HIGH SCHOOL RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46224-4723
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2915 N HIGH SCHOOL RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46224-4723
Country	:	US
Telephone Number	:	305-502-9422
Fax Number	:

Authorized Official
Title or Position	:	GENERAL MANAGER
Name	:	DANIEL DUGE
Credential	:
Telephone Number	:	305-502-9422

Provider Enumeration Date	:	10/24/2023
Last Update Date	:	10/24/2023

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