Provider Demographics
NPI:1831100106
Name:SOUTHERN RIPLEY COUNTY EMERGENCY LIFE SQUAD INC
Entity Type:Organization
Organization Name:SOUTHERN RIPLEY COUNTY EMERGENCY LIFE SQUAD INC
Other - Org Name:RESCUE 69
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:COZART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-689-5897
Mailing Address - Street 1:10361 SPARTAN DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-1220
Mailing Address - Country:US
Mailing Address - Phone:800-962-1484
Mailing Address - Fax:513-772-4464
Practice Address - Street 1:727 W HOPEWELL RD
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:IN
Practice Address - Zip Code:47042-7324
Practice Address - Country:US
Practice Address - Phone:812-689-3179
Practice Address - Fax:812-689-4521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100289790AMedicaid
P00241206OtherRAILROAD MEDICARE
IN2000000191167OtherANTHEM