Healthcare Provider Details

I. General information

NPI: 1326478629
Provider Name (Legal Business Name): DAMAR TRANSPORTATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2013
Last Update Date: 11/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6067 DECATUR BLVD
INDIANAPOLIS IN
46241-9606
US

IV. Provider business mailing address

6067 DECATUR BLVD
INDIANAPOLIS IN
46241-9606
US

V. Phone/Fax

Practice location:
  • Phone: 317-856-5201
  • Fax: 317-856-2333
Mailing address:
  • Phone: 317-856-5201
  • Fax: 317-856-2333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: DR. JIM L DALTON
Title or Position: PRESIDENT
Credential: PSY.D., HSPP
Phone: 317-856-5201