Healthcare Provider Details

I. General information

NPI: 1396954236
Provider Name (Legal Business Name): ALAN DEAN GLEGHORN TRANSPORTATION
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1424 N TIBBS AVE
INDIANAPOLIS IN
46222-3026
US

IV. Provider business mailing address

1424 N TIBBS AVE
INDIANAPOLIS IN
46222-3026
US

V. Phone/Fax

Practice location:
  • Phone: 317-634-1316
  • Fax: 317-634-0631
Mailing address:
  • Phone: 317-634-1316
  • Fax: 317-634-0631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number8908-42-9702
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: