Healthcare Provider Details

I. General information

NPI: 1144461666
Provider Name (Legal Business Name): ZOOM TRANSPORT SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2009
Last Update Date: 03/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 CARROLLTON AVE
INDIANAPOLIS IN
46202-2714
US

IV. Provider business mailing address

1425 CARROLLTON AVE
INDIANAPOLIS IN
46202-2714
US

V. Phone/Fax

Practice location:
  • Phone: 317-710-3219
  • Fax:
Mailing address:
  • Phone: 317-710-3219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateIN

VIII. Authorized Official

Name: CHARLES KENNEDY JR.
Title or Position: OWNER/OPERATOR
Credential:
Phone: 317-710-3219