Healthcare Provider Details

I. General information

NPI: 1578617593
Provider Name (Legal Business Name): ST TAMMANY FIRE PROTECTION DISTRICT 11
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64279 HWY 3081
PEARL RIVER LA
70452
US

IV. Provider business mailing address

PO BOX 1210
PEARL RIVER LA
70452
US

V. Phone/Fax

Practice location:
  • Phone: 985-863-3132
  • Fax: 985-863-1834
Mailing address:
  • Phone: 985-863-3132
  • Fax: 985-863-1834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberPENDING
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number9110094
License Number StateLA

VIII. Authorized Official

Name: PAMELA LITTLE
Title or Position: DIRECTOR OF EMS
Credential:
Phone: 985-863-3132