Healthcare Provider Details

I. General information

NPI: 1538729785
Provider Name (Legal Business Name): LIFEWAY MEDICAL TRANSPORT,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2019
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5637 MEMORIAL DR
VIRGINIA BEACH VA
23455-3875
US

IV. Provider business mailing address

5637 MEMORIAL DR
VIRGINIA BEACH VA
23455-3875
US

V. Phone/Fax

Practice location:
  • Phone: 757-937-8162
  • Fax: 757-524-5024
Mailing address:
  • Phone: 757-937-8162
  • Fax: 757-524-5024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MARQUIS THOMPSON
Title or Position: OWNER
Credential:
Phone: 757-937-8162