Organization
RUSSELLVILLE VOLUNTEER LIFE SQUAD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYLAR SIMPSON (CAPTAIN)
(937) 515-7288
Entity
Organization
Contact information
Practice address
130 W SOUTH ST, RUSSELLVILLE, OH 45168-7504
(937) 373-2581
Mailing address
PO BOX 392907, PITTSBURGH, PA 15251-9907
(800) 962-1484
(513) 772-4464
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000020170
ANTHEM
OH
05
—
2065205
—
OH
01
—
590014125
RAILROAD MEDICARE
OH
Enumeration date
07/29/2005
Last updated
03/27/2025
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