Healthcare Provider Details

I. General information

NPI: 1457358996
Provider Name (Legal Business Name): LAFOURCHE AMBULANCE DISTRICT NO. 1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17078 W MAIN ST
CUT OFF LA
70345-4102
US

IV. Provider business mailing address

17078 W MAIN ST
CUT OFF LA
70345-4102
US

V. Phone/Fax

Practice location:
  • Phone: 985-632-7192
  • Fax: 985-632-7198
Mailing address:
  • Phone: 985-632-7192
  • Fax: 985-632-7198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number9110022
License Number StateLA

VIII. Authorized Official

Name: MRS. DEBORAH G. GAUTREAUX
Title or Position: ADMINISTRATOR
Credential:
Phone: 985-632-7192