Provider Demographics
NPI:1114952751
Name:NORTHSHORE EMS LLC
Entity Type:Organization
Organization Name:NORTHSHORE EMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BRENNAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:985-735-5907
Mailing Address - Street 1:153 MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-3925
Mailing Address - Country:US
Mailing Address - Phone:985-735-5907
Mailing Address - Fax:985-735-5916
Practice Address - Street 1:153 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-3925
Practice Address - Country:US
Practice Address - Phone:985-735-5907
Practice Address - Fax:985-735-5916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA91100863416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA47136Medicare ID - Type Unspecified