MEDICARE: HOUSTON 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	341600000X	Ambulance

General Provider Information

NPI Number	:	1659927739
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOUSTON RESCUE SQUAD, INC.

Provider Business Mailing Address
First Line	:	PO BOX 397
Second Line	:
City	:	HOUSTON
State	:	OH
Zip	:	45333-0397
Country	:	US
Telephone Number	:	937-821-0059
Fax Number	:

Provider Business Practice Location Address
First Line	:	5125 RUSSIA HOUSTON RD
Second Line	:
City	:	HOUSTON
State	:	OH
Zip	:	45333-9802
Country	:	US
Telephone Number	:	937-541-2210
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. BRIAN K HATHAWAY
Credential	:
Telephone Number	:	937-821-0059

Provider Enumeration Date	:	08/14/2019
Last Update Date	:	07/15/2021

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