MEDICARE: RUSSELLVILLE VOLUNTEER LIFE SQUAD

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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	590014125	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000020170	OTHER	OH	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669472890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUSSELLVILLE VOLUNTEER LIFE SQUAD

Provider Business Mailing Address
First Line	:	PO BOX 392907
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15251-9907
Country	:	US
Telephone Number	:	800-962-1484
Fax Number	:	513-772-4464

Provider Business Practice Location Address
First Line	:	130 W SOUTH ST
Second Line	:
City	:	RUSSELLVILLE
State	:	OH
Zip	:	45168-7504
Country	:	US
Telephone Number	:	937-373-2581
Fax Number	:

Authorized Official
Title or Position	:	CAPTAIN
Name	:	TYLAR SIMPSON
Credential	:
Telephone Number	:	937-515-7288

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	03/27/2025

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Directions to “RUSSELLVILLE VOLUNTEER LIFE SQUAD ” Practice Location

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