Provider Demographics
NPI:1841279189
Name:MARION LIFE SAVING CREW
Entity type:Organization
Organization Name:MARION LIFE SAVING CREW
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CLARENCE
Authorized Official - Last Name:SHUPE
Authorized Official - Suffix:JR
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:276-783-4500
Mailing Address - Street 1:MARION LIFE SAVING CREW INC.
Mailing Address - Street 2:PO BOX 784
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-0784
Mailing Address - Country:US
Mailing Address - Phone:276-783-4500
Mailing Address - Fax:276-783-1442
Practice Address - Street 1:230 S PARK ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-2929
Practice Address - Country:US
Practice Address - Phone:276-783-4500
Practice Address - Fax:276-783-1442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2053416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0000000397107OtherBLUE CROSS BLUE SHIELD