MEDICARE: YELLOW BREECHES EMS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	05009	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275693814
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YELLOW BREECHES EMS, INC.

Provider Business Mailing Address
First Line	:	233 MILL ST
Second Line	:
City	:	MOUNT HOLLY SPRINGS
State	:	PA
Zip	:	17065-1718
Country	:	US
Telephone Number	:	717-486-3833
Fax Number	:

Provider Business Practice Location Address
First Line	:	233 MILL ST
Second Line	:
City	:	MOUNT HOLLY SPRINGS
State	:	PA
Zip	:	17065-1718
Country	:	US
Telephone Number	:	717-486-3833
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DOUG SHIELDS
Credential	:
Telephone Number	:	717-486-3833

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	06/17/2015

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Directions to “YELLOW BREECHES EMS, INC. ” Practice Location

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