MEDICARE: DESOTO PARISH AMBULANCE SERVICE DISTRICT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	9110077	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134128804
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESOTO PARISH AMBULANCE SERVICE DISTRICT

Provider Business Mailing Address
First Line	:	PO BOX 863
Second Line	:	208 GIBBS ST.
City	:	MANSFIELD
State	:	LA
Zip	:	71052-0863
Country	:	US
Telephone Number	:	318-872-0221
Fax Number	:	318-872-5997

Provider Business Practice Location Address
First Line	:	208 GIBBS ST
Second Line	:
City	:	MANSFIELD
State	:	LA
Zip	:	71052-2632
Country	:	US
Telephone Number	:	318-872-0221
Fax Number	:	318-872-5997

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. JOE DOUGLAS MAGEE
Credential	:	EMT-P
Telephone Number	:	318-872-0221

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	10/04/2007

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Directions to “DESOTO PARISH AMBULANCE SERVICE DISTRICT ” Practice Location

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