Healthcare Provider Details

I. General information

NPI: 1255740536
Provider Name (Legal Business Name): CELADON TRUCKING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2014
Last Update Date: 08/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9503 E 33RD ST
INDIANAPOLIS IN
46235-4207
US

IV. Provider business mailing address

9503 E 33RD ST
INDIANAPOLIS IN
46235-4207
US

V. Phone/Fax

Practice location:
  • Phone: 317-972-7000
  • Fax: 317-829-6384
Mailing address:
  • Phone: 317-972-7000
  • Fax: 317-829-6384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: LAURYN BLACHA
Title or Position: BENEFITS MANAGER
Credential:
Phone: 317-972-7000