Provider Demographics
NPI:1780610063
Name:HOLBROOK EMS INC.
Entity type:Organization
Organization Name:HOLBROOK EMS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-524-2190
Mailing Address - Street 1:30 W VISTA DR
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:AZ
Mailing Address - Zip Code:86025-1840
Mailing Address - Country:US
Mailing Address - Phone:928-524-2190
Mailing Address - Fax:928-524-1477
Practice Address - Street 1:30 W VISTA DR
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:AZ
Practice Address - Zip Code:86025-1840
Practice Address - Country:US
Practice Address - Phone:928-524-2190
Practice Address - Fax:928-524-1477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0151060OtherBLUE CROSS BLUE SHIELD
AZZ=========Medicare ID - Type Unspecified
AZ071837Medicare ID - Type Unspecified
590005381Medicare ID - Type UnspecifiedRAILROAD