Provider Demographics
NPI:1841290087
Name:RIPLEY LIFE SQUAD
Entity type:Organization
Organization Name:RIPLEY LIFE SQUAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-392-4900
Mailing Address - Street 1:PO BOX 174
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:OH
Mailing Address - Zip Code:45167-0174
Mailing Address - Country:US
Mailing Address - Phone:800-962-1484
Mailing Address - Fax:513-772-4464
Practice Address - Street 1:799 S 2ND ST
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:OH
Practice Address - Zip Code:45167-1309
Practice Address - Country:US
Practice Address - Phone:937-392-4900
Practice Address - Fax:937-392-4099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000006270OtherANTHEM
OH590012190OtherRAILROAD MEDICARE
OH0291910Medicaid
OH=========003OtherMEDICAL MUTUAL OF OHIO
OH000000006270OtherANTHEM