MEDICARE: CELADON TRUCKING

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	347E00000X	Transportation Broker

General Provider Information

NPI Number	:	1255740536
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CELADON TRUCKING

Provider Business Mailing Address
First Line	:	9503 E 33RD ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46235-4207
Country	:	US
Telephone Number	:	317-972-7000
Fax Number	:	317-829-6384

Provider Business Practice Location Address
First Line	:	9503 E 33RD ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46235-4207
Country	:	US
Telephone Number	:	317-972-7000
Fax Number	:	317-829-6384

Authorized Official
Title or Position	:	BENEFITS MANAGER
Name	:	LAURYN BLACHA
Credential	:
Telephone Number	:	317-972-7000

Provider Enumeration Date	:	08/12/2014
Last Update Date	:	08/12/2014

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Directions to “CELADON TRUCKING ” Practice Location

Language	Start Address	Practice Location

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