Provider Demographics
NPI:1164422309
Name:SARDINIA LIFE SQUAD AND RESCUE UNIT OF BROWN COUNTY
Entity Type:Organization
Organization Name:SARDINIA LIFE SQUAD AND RESCUE UNIT OF BROWN COUNTY
Other - Org Name:SARDINIA LIFE SQUAD AND RESCUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:DARCY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-490-1676
Mailing Address - Street 1:PO BOX 621005
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45262-1005
Mailing Address - Country:US
Mailing Address - Phone:800-962-1484
Mailing Address - Fax:513-772-4464
Practice Address - Street 1:159 WINCHESTER ST
Practice Address - Street 2:
Practice Address - City:SARDINIA
Practice Address - State:OH
Practice Address - Zip Code:45171-9326
Practice Address - Country:US
Practice Address - Phone:937-446-2178
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000006280OtherANTHEM
OH0292115Medicaid
OH590011932OtherRAILROAD MEDICARE
OH000000006280OtherANTHEM