Provider Demographics
NPI:1619952082
Name:LOWER CAMERON AMBULANCE DISTRICT
Entity Type:Organization
Organization Name:LOWER CAMERON AMBULANCE DISTRICT
Other - Org Name:CAMERON PARISH EMERGENCY MEDICAL SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:BROUSSARD
Authorized Official - Suffix:
Authorized Official - Credentials:NREMT-P
Authorized Official - Phone:337-542-4926
Mailing Address - Street 1:PO BOX 248
Mailing Address - Street 2:
Mailing Address - City:CREOLE
Mailing Address - State:LA
Mailing Address - Zip Code:70632
Mailing Address - Country:US
Mailing Address - Phone:337-542-4926
Mailing Address - Fax:337-542-4924
Practice Address - Street 1:137 OLIVER RD
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:LA
Practice Address - Zip Code:70631
Practice Address - Country:US
Practice Address - Phone:337-542-4926
Practice Address - Fax:337-542-4924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-08
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9110074341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1437328Medicaid
LA47125Medicare UPIN
LA1437328Medicaid