Provider Demographics
NPI:1275693814
Name:YELLOW BREECHES EMS, INC.
Entity Type:Organization
Organization Name:YELLOW BREECHES EMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-486-3833
Mailing Address - Street 1:233 MILL ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY SPRINGS
Mailing Address - State:PA
Mailing Address - Zip Code:17065-1718
Mailing Address - Country:US
Mailing Address - Phone:717-486-3833
Mailing Address - Fax:
Practice Address - Street 1:233 MILL ST
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY SPRINGS
Practice Address - State:PA
Practice Address - Zip Code:17065-1718
Practice Address - Country:US
Practice Address - Phone:717-486-3833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA050093416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3416L0300XTransportation ServicesAmbulanceLand TransportGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016806710004Medicaid
PA0016806710004Medicaid