Active NPI
Lebanon Lifesaving Crew Incorporated
- Land Ambulance
- Lebanon, VA
National Provider Identifier
1184690372
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Land Ambulance
- Legal business name
- LEBANON LIFESAVING CREW INCORPORATED
- Practice address
- 60 South Church Street
Lebanon, VA 24266-4412 - Phone
- (276) 889-2674
- Fax
- (276) 889-4898
- NPI assigned
- Feb 27, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Nolan Stevens
- Title
- Captain
- Phone
- (276) 889-2674
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | Primary |
Addresses
Primary practice location
60 South Church Street
Lebanon, VA 24266-4412
Mailing address
PO Box 9150
Paducah, KY 42002-9150
Phone (270) 744-8413
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184690372 | Medicaid | VA | |
| 590015121 | Other | VA | RAILROAD MEDICARE |
Other names 1
- Lebanon Life Saving Crew Inc.
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050113001152 | VA | Part B Supplier - Ambulance Service Supplier | 0143296046 | Practice locations: Lebanon, VA |
National Provider Directory
National Provider DirectoryLocations
210 S Church St
Lebanon, VA 24266
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140998400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1632441600000",
"number": "1184690372",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 9150",
"city": "PADUCAH",
"state": "KY",
"postal_code": "420029150",
"telephone_number": "270-744-8413",
"fax_number": "270-744-8642"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "60 SOUTH CHURCH STREET",
"city": "LEBANON",
"state": "VA",
"postal_code": "242664412",
"telephone_number": "276-889-2674",
"fax_number": "276-889-4898"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LEBANON LIFESAVING CREW INCORPORATED",
"organizational_subpart": "NO",
"enumeration_date": "2006-02-27",
"last_updated": "2021-09-24",
"certification_date": "2021-09-24",
"status": "A",
"authorized_official_last_name": "STEVENS",
"authorized_official_first_name": "NOLAN",
"authorized_official_title_or_position": "CAPTAIN",
"authorized_official_telephone_number": "276-889-2674",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "3416L0300X",
"taxonomy_group": "",
"desc": "Ambulance, Land Transport",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1184690372",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "590015121",
"state": "VA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Lebanon Life Saving Crew Inc.",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Lebanon Life Saving Crew Inc.",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Lebanon, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.