Provider Demographics
NPI:1477057057
Name:PRESTIGE TRANSPORTATION SERVICES
Entity Type:Organization
Organization Name:PRESTIGE TRANSPORTATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:317-939-9033
Mailing Address - Street 1:4007 SHADOW POINTE LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-3754
Mailing Address - Country:US
Mailing Address - Phone:317-939-9033
Mailing Address - Fax:
Practice Address - Street 1:4007 SHADOW POINTE LN
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-3754
Practice Address - Country:US
Practice Address - Phone:317-939-9033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2350486683343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)