MEDICARE: JACKSON CENTER RESCUE SQUAD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	590009255	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000006165	OTHER	OH	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285635060
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACKSON CENTER RESCUE SQUAD INC

Provider Business Mailing Address
First Line	:	PO BOX 4
Second Line	:
City	:	JACKSON CENTER
State	:	OH
Zip	:	45334-0004
Country	:	US
Telephone Number	:	937-596-6640
Fax Number	:	937-596-6640

Provider Business Practice Location Address
First Line	:	523 N MAIN
Second Line	:
City	:	JACKSON CENTER
State	:	OH
Zip	:	45334
Country	:	US
Telephone Number	:	937-596-6640
Fax Number	:	937-596-6640

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JILL LUDWIG
Credential	:
Telephone Number	:	937-658-0006

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	03/12/2010

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