Healthcare Provider Details

I. General information

NPI: 1245905421
Provider Name (Legal Business Name): GRAY EAGLE TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 08/10/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8650 COMMERCE PARK PL STE A1
INDIANAPOLIS IN
46268-3174
US

IV. Provider business mailing address

8650 COMMERCE PARK PL STE A1
INDIANAPOLIS IN
46268-3174
US

V. Phone/Fax

Practice location:
  • Phone: 317-536-3585
  • Fax:
Mailing address:
  • Phone: 317-536-3585
  • 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

VIII. Authorized Official

Name: CORY GRAY
Title or Position: CEO
Credential:
Phone: 317-480-2875