Healthcare Provider Details

I. General information

NPI: 1295380905
Provider Name (Legal Business Name): INDY TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 08/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2936 E WASHINGTON ST APT 11
INDIANAPOLIS IN
46201-4294
US

IV. Provider business mailing address

2936 E WASHINGTON ST APT 11
INDIANAPOLIS IN
46201-4294
US

V. Phone/Fax

Practice location:
  • Phone: 317-457-5714
  • Fax:
Mailing address:
  • Phone: 317-457-5714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: ABRAHAM TESEAMARIAM GHIDAY
Title or Position: CEO
Credential:
Phone: 317-457-5714