Healthcare Provider Details

I. General information

NPI: 1093896391
Provider Name (Legal Business Name): ESTHERVILLE AMBULANCE SERVICE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 N 1ST ST
ESTHERVILLE IA
51334-2101
US

IV. Provider business mailing address

10802 FARNAM DR
OMAHA NE
68154-3237
US

V. Phone/Fax

Practice location:
  • Phone: 712-362-4221
  • Fax: 712-362-4221
Mailing address:
  • Phone: 877-218-4392
  • Fax: 877-343-0131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberPS-18-018-07
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: MR. BRAD HELD
Title or Position: SERVICE CO - DIRECTOR
Credential:
Phone: 531-895-5853