MEDICARE: ZIMMYRA DEAN

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
2	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1831664960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZIMMYRA DEAN

Provider Business Mailing Address
First Line	:	4836 COVERED BRIDGE RD APT D
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-3426
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4836 COVERED BRIDGE RD APT D
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-3426
Country	:	US
Telephone Number	:	260-302-2880
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2018
Last Update Date	:	10/08/2018

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Directions to “ ZIMMYRA DEAN ” Practice Location

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