Provider Demographics
NPI:1245218452
Name:BALENTINE AMBULANCE SERVICE INC.
Entity Type:Organization
Organization Name:BALENTINE AMBULANCE SERVICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:B
Authorized Official - Last Name:MCBEATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-222-5358
Mailing Address - Street 1:PO BOX 3922
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71133-3922
Mailing Address - Country:US
Mailing Address - Phone:318-222-5358
Mailing Address - Fax:318-221-2340
Practice Address - Street 1:3516 MANSFIELD RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-4400
Practice Address - Country:US
Practice Address - Phone:318-222-5358
Practice Address - Fax:318-221-2340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-06
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9110006341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR133967715Medicaid
LA38131OtherBLUE CROSS-BLUE SHIELD LA
LA0004520555OtherAETNA US HEALTHCARE
LA1368288Medicaid
LA38131OtherBLUE CROSS-BLUE SHIELD LA
LA47044Medicare ID - Type UnspecifiedMEDICARE PART B
AR133967715Medicaid