=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841290087
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RIPLEY LIFE SQUAD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2005
-----------------------------------------------------
Last Update Date | 02/28/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 799 S 2ND ST
-----------------------------------------------------
City | RIPLEY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45167-1309
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-392-4900
-----------------------------------------------------
Fax | 937-392-4099
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 174
-----------------------------------------------------
City | RIPLEY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45167-0174
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-962-1484
-----------------------------------------------------
Fax | 513-772-4464
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FIRE CHIEF
-----------------------------------------------------
Name | JEFF SHELTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 937-392-4900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------