MEDICARE: BALENTINE AMBULANCE SERVICE INC.

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	341600000X	Ambulance	9110006	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
2	38131	OTHER	LA	BLUE CROSS-BLUE SHIELD LA
3	0004520555	OTHER	LA	AETNA US HEALTHCARE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245218452
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALENTINE AMBULANCE SERVICE INC.

Provider Business Mailing Address
First Line	:	PO BOX 3922
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71133-3922
Country	:	US
Telephone Number	:	318-222-5358
Fax Number	:	318-221-2340

Provider Business Practice Location Address
First Line	:	3516 MANSFIELD RD
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71103-4400
Country	:	US
Telephone Number	:	318-222-5358
Fax Number	:	318-221-2340

Authorized Official
Title or Position	:	PRESIDENT-CEO
Name	:	MRS. PAMELA B MCBEATH
Credential	:
Telephone Number	:	318-222-5358

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	10/07/2011

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