Provider Demographics
NPI:1104996040
Name:GRAND ISLE VOLUNTEER EMERGENCY SERVICES, INC
Entity type:Organization
Organization Name:GRAND ISLE VOLUNTEER EMERGENCY SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-787-2777
Mailing Address - Street 1:PO BOX 776
Mailing Address - Street 2:
Mailing Address - City:SLIPPERY ROCK
Mailing Address - State:PA
Mailing Address - Zip Code:16057-0776
Mailing Address - Country:US
Mailing Address - Phone:800-280-5974
Mailing Address - Fax:724-794-1633
Practice Address - Street 1:100 CHIGHIZOLA
Practice Address - Street 2:
Practice Address - City:GRAND ISLE
Practice Address - State:LA
Practice Address - Zip Code:70538-1035
Practice Address - Country:US
Practice Address - Phone:985-787-2777
Practice Address - Fax:724-794-1633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMT00041853416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1667471Medicaid
LAC5587Medicare UPIN
LA47148Medicare PIN
LA1667471Medicaid