Healthcare Provider Details

I. General information

NPI: 1043204001
Provider Name (Legal Business Name): PEEBLES LIFE SQUAD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MARBLE FURNACE RD
PEEBLES OH
45660-1215
US

IV. Provider business mailing address

150 MARBLE FURNACE RD
PEEBLES OH
45660-1215
US

V. Phone/Fax

Practice location:
  • Phone: 937-587-3598
  • Fax: 937-578-3602
Mailing address:
  • Phone: 937-587-3598
  • Fax: 937-578-3602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberN/A
License Number StateOH

VIII. Authorized Official

Name: BETTY J HEDRICK
Title or Position: CHIEF
Credential: EMT
Phone: 937-587-2386