Healthcare Provider Details

I. General information

NPI: 1124875596
Provider Name (Legal Business Name): INDRIVE TRANSPOTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2024
Last Update Date: 05/03/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1266 PENNY LN
DEKALB IL
60115-5828
US

IV. Provider business mailing address

1266 PENNY LN
DEKALB IL
60115-5828
US

V. Phone/Fax

Practice location:
  • Phone: 779-255-2296
  • Fax:
Mailing address:
  • Phone: 779-255-2296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: AMIR ALI
Title or Position: MANAGER
Credential:
Phone: 779-255-2296