Provider Demographics
NPI:1891862306
Name:DAYTON RESCUE SQUAD
Entity Type:Organization
Organization Name:DAYTON RESCUE SQUAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SEC TREAS
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:ELIFRITS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-547-2252
Mailing Address - Street 1:27 1ST AVE SW
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:IA
Mailing Address - Zip Code:50530-7661
Mailing Address - Country:US
Mailing Address - Phone:515-547-2252
Mailing Address - Fax:
Practice Address - Street 1:27 1ST AVE SW
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:IA
Practice Address - Zip Code:50530-7661
Practice Address - Country:US
Practice Address - Phone:515-547-2252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2940300146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0092650Medicaid
IA0092650Medicaid