Provider Demographics
NPI:1457358996
Name:LAFOURCHE AMBULANCE DISTRICT NO. 1
Entity Type:Organization
Organization Name:LAFOURCHE AMBULANCE DISTRICT NO. 1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:G
Authorized Official - Last Name:GAUTREAUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-632-7192
Mailing Address - Street 1:17078 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CUT OFF
Mailing Address - State:LA
Mailing Address - Zip Code:70345-4102
Mailing Address - Country:US
Mailing Address - Phone:985-632-7192
Mailing Address - Fax:985-632-7198
Practice Address - Street 1:17078 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CUT OFF
Practice Address - State:LA
Practice Address - Zip Code:70345-4102
Practice Address - Country:US
Practice Address - Phone:985-632-7192
Practice Address - Fax:985-632-7198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA91100223416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1193925Medicaid
LA47038Medicare ID - Type UnspecifiedPROVIDER NUMBER