Healthcare Provider Details

I. General information

NPI: 1073513206
Provider Name (Legal Business Name): GEORGETOWN VOLUNTEER LIFE SQUAD ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 03/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 MT. ORAB PIKE
GEORGETOWN OH
45121
US

IV. Provider business mailing address

PO BOX 184
GEORGETOWN OH
45121-0184
US

V. Phone/Fax

Practice location:
  • Phone: 937-378-3082
  • Fax: 937-378-4709
Mailing address:
  • Phone: 937-291-7850
  • Fax: 937-291-2971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: ANITA MCKINZIE
Title or Position: EMS
Credential:
Phone: 937-378-2101