1710031091 NPI number — D'ARBONNE AMBULANCE SERVICE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710031091 NPI number — D'ARBONNE AMBULANCE SERVICE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
D'ARBONNE AMBULANCE SERVICE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710031091
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1109 MARION HWY
Provider Second Line Business Mailing Address:
P.O. BOX 311
Provider Business Mailing Address City Name:
FARMERVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71241-9313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-368-7033
Provider Business Mailing Address Fax Number:
318-368-8603

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1109 MARION HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARMERVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71241-9313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-368-7033
Provider Business Practice Location Address Fax Number:
318-368-8603
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HYDE
Authorized Official First Name:
STEPHAN
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
318-368-7033

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  9110015 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1962121 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 53001 . This is a "BLUE CROSS PROV. NUMBER" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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