# SOUTHERN RIPLEY COUNTY EMERGENCY LIFE SQUAD INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Rescue 69
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831100106
- **Authorized official:** CHARLES COZART (CHIEF)
- **Authorized official phone:** (812) 689-5897

## Contact information

- **Practice address:** 727 W HOPEWELL RD, VERSAILLES, IN 47042-7324
- **Practice address phone:** (812) 689-3179
- **Practice address fax:** (812) 689-4521
- **Mailing address:** 10361 SPARTAN DR, CINCINNATI, OH 45215-1220
- **Mailing address phone:** (800) 962-1484
- **Mailing address fax:** (513) 772-4464

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 341600000X | Ambulance | — | NULL | Yes |

## Other

- **Enumeration date:** 08/11/2006
- **Last updated:** 11/26/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100289790A | — | IN |
| 01 | — | 2000000191167 | ANTHEM | IN |
| 01 | — | P00241206 | RAILROAD MEDICARE | — |