MEDICARE: DAVENPORT LIFE SAVING CREW INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance

General Provider Information

NPI Number	:	1538847371
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVENPORT LIFE SAVING CREW INC

Provider Business Mailing Address
First Line	:	4033 COUNCIL MOUNTAIN RD
Second Line	:
City	:	HONAKER
State	:	VA
Zip	:	24260-4902
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4014 HELEN HENDERSON HWY
Second Line	:
City	:	DAVENPORT
State	:	VA
Zip	:	24239-0000
Country	:	US
Telephone Number	:	276-859-7108
Fax Number	:

Authorized Official
Title or Position	:	CAPTAIN
Name	:	DONALD TERRY AUSTIN
Credential	:
Telephone Number	:	276-202-9413

Provider Enumeration Date	:	07/11/2023
Last Update Date	:	07/13/2023

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Directions to “DAVENPORT LIFE SAVING CREW INC ” Practice Location

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