Provider Demographics
NPI:1912949652
Name:NORTHEAST LA AMBULANCE SVC LLC
Entity type:Organization
Organization Name:NORTHEAST LA AMBULANCE SVC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:ELDRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:318-435-8351
Mailing Address - Street 1:PO BOX 27
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:LA
Mailing Address - Zip Code:71295
Mailing Address - Country:US
Mailing Address - Phone:318-435-8351
Mailing Address - Fax:318-435-8319
Practice Address - Street 1:233 TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:LA
Practice Address - Zip Code:71295
Practice Address - Country:US
Practice Address - Phone:318-435-8351
Practice Address - Fax:318-435-8319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9110044341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1560782Medicaid
LA47119Medicare ID - Type Unspecified