MEDICARE: INDYGO 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	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1962114439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDYGO TRANSPORT LLC

Provider Business Mailing Address
First Line	:	2220 S FRASER ST UNIT 2
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80014-4508
Country	:	US
Telephone Number	:	720-939-4020
Fax Number	:

Provider Business Practice Location Address
First Line	:	2220 S FRASER ST UNIT 2
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80014-4508
Country	:	US
Telephone Number	:	720-939-4020
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	ASFAW GOBENA KUTURE
Credential	:
Telephone Number	:	720-939-4020

Provider Enumeration Date	:	12/15/2022
Last Update Date	:	12/15/2022

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Directions to “INDYGO TRANSPORT LLC ” Practice Location

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