Provider Demographics
NPI:1134128804
Name:DESOTO PARISH AMBULANCE SERVICE DISTRICT
Entity Type:Organization
Organization Name:DESOTO PARISH AMBULANCE SERVICE DISTRICT
Other - Org Name:DESOTO PARISH EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:MAGEE
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-P
Authorized Official - Phone:318-872-0221
Mailing Address - Street 1:PO BOX 863
Mailing Address - Street 2:208 GIBBS ST.
Mailing Address - City:MANSFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71052-0863
Mailing Address - Country:US
Mailing Address - Phone:318-872-0221
Mailing Address - Fax:318-872-5997
Practice Address - Street 1:208 GIBBS ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:LA
Practice Address - Zip Code:71052-2632
Practice Address - Country:US
Practice Address - Phone:318-872-0221
Practice Address - Fax:318-872-5997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-15
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA91100773416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1138002Medicaid
LA1138002Medicaid