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General NPI Number Information
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NPI Number | 1841279189
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Entity Type | Organization
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Legal Business Name | MARION LIFE SAVING CREW
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Dates
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Enumeration Date | 01/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 230 S PARK ST
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City | MARION
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State | VA
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Zip | 24354-2929
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Country | US
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Telephone | 276-783-4500
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Fax | 276-783-1442
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Provider Business Mailing Address
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Address Line | MARION LIFE SAVING CREW INC. PO BOX 784
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City | MARION
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State | VA
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Zip | 24354-0784
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Country | US
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Telephone | 276-783-4500
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Fax | 276-783-1442
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Authorized Official
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Title or Position | BILLING OFFICER
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Name | JAMES CLARENCE SHUPE JR.
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Credential | PARAMEDIC
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Telephone | 276-783-4500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 205
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License Number State | VA
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