Provider Demographics
NPI:1508892969
Name:UNION TOWNSHIP LIFE SQUAD, INC.
Entity type:Organization
Organization Name:UNION TOWNSHIP LIFE SQUAD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIKERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-698-8857
Mailing Address - Street 1:PO BOX 392907
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15251-9907
Mailing Address - Country:US
Mailing Address - Phone:800-962-1484
Mailing Address - Fax:513-772-4464
Practice Address - Street 1:4960 DAVIS RD
Practice Address - Street 2:
Practice Address - City:WEST MILTON
Practice Address - State:OH
Practice Address - Zip Code:45383-7734
Practice Address - Country:US
Practice Address - Phone:937-698-7507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000155176OtherANTHEM
OH2202262Medicaid
OH000000155176OtherANTHEM
OH2202262Medicaid