MEDICARE: INDY 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)	2350-88-5934	IN

General Provider Information

NPI Number	:	1194095281
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDY TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	2353 COURTNEY RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-1201
Country	:	US
Telephone Number	:	317-384-6315
Fax Number	:

Provider Business Practice Location Address
First Line	:	2353 COURTNEY RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-1201
Country	:	US
Telephone Number	:	317-384-6315
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. CURISA DAVIS
Credential	:
Telephone Number	:	317-384-6315

Provider Enumeration Date	:	01/05/2012
Last Update Date	:	01/05/2012

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