# GEORGETOWN VOLUNTEER LIFE SQUAD ASSOCIATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Georgetown Life Squad
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073513206
- **Authorized official:** ANITA MCKINZIE (EMS)
- **Authorized official phone:** (937) 378-2101

## Contact information

- **Practice address:** 821 MT. ORAB PIKE, GEORGETOWN, OH 45121
- **Practice address phone:** (937) 378-3082
- **Practice address fax:** (937) 378-4709
- **Mailing address:** PO BOX 184, GEORGETOWN, OH 45121-0184
- **Mailing address phone:** (937) 291-7850
- **Mailing address fax:** (937) 291-2971

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | — | NULL | Yes |

## Other

- **Enumeration date:** 07/29/2005
- **Last updated:** 03/13/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000006129 | ANTHEM | OH |
| 05 | — | 0294168 | — | OH |