Provider Demographics
NPI:1285635060
Name:JACKSON CENTER RESCUE SQUAD INC
Entity Type:Organization
Organization Name:JACKSON CENTER RESCUE SQUAD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:LUDWIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-658-0006
Mailing Address - Street 1:PO BOX 4
Mailing Address - Street 2:
Mailing Address - City:JACKSON CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:45334-0004
Mailing Address - Country:US
Mailing Address - Phone:937-596-6640
Mailing Address - Fax:937-596-6640
Practice Address - Street 1:523 N MAIN
Practice Address - Street 2:
Practice Address - City:JACKSON CENTER
Practice Address - State:OH
Practice Address - Zip Code:45334
Practice Address - Country:US
Practice Address - Phone:937-596-6640
Practice Address - Fax:937-596-6640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-03
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000006165OtherANTHEM
OH0417712Medicaid
OH590009255OtherRAILROAD MEDICARE
OH590009255OtherRAILROAD MEDICARE