Provider Demographics
NPI:1477599470
Name:HOLBROOK EMERGENCY MEDICAL SERVICES
Entity Type:Organization
Organization Name:HOLBROOK EMERGENCY MEDICAL SERVICES
Other - Org Name:HOLBROOK EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AMBULANCE CHIEF
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:HELMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-572-4019
Mailing Address - Street 1:PO BOX 641880
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-7880
Mailing Address - Country:US
Mailing Address - Phone:402-572-4019
Mailing Address - Fax:402-965-8594
Practice Address - Street 1:305 CENTER AVENUE
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NE
Practice Address - Zip Code:68948
Practice Address - Country:US
Practice Address - Phone:402-572-4019
Practice Address - Fax:402-965-8594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11523416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025360900Medicaid
NE39446OtherBLUE CROSS BLUE SHIELD PR
NE10025360900Medicaid