MEDICARE: TRUSTED CARRIAGE TRANSPORTATION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)	0000001	IN

General Provider Information

NPI Number	:	1013392521
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRUSTED CARRIAGE TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	PO BOX 532022
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46253-2022
Country	:	US
Telephone Number	:	888-510-1221
Fax Number	:	317-991-3564

Provider Business Practice Location Address
First Line	:	4814 SHADOW POINTE DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-3743
Country	:	US
Telephone Number	:	317-531-8882
Fax Number	:	317-991-3564

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. DONYA LATRICE ELLIS
Credential	:
Telephone Number	:	317-531-8882

Provider Enumeration Date	:	07/26/2015
Last Update Date	:	07/26/2015

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