Provider Demographics
NPI:1295380905
Name:INDY TRANSPORTATION LLC
Entity Type:Organization
Organization Name:INDY TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:TESEAMARIAM
Authorized Official - Last Name:GHIDAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-457-5714
Mailing Address - Street 1:2936 E WASHINGTON ST APT 11
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46201-4294
Mailing Address - Country:US
Mailing Address - Phone:317-457-5714
Mailing Address - Fax:
Practice Address - Street 1:2936 E WASHINGTON ST APT 11
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46201-4294
Practice Address - Country:US
Practice Address - Phone:317-457-5714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)