Provider Demographics
NPI:1316743636
Name:BOSTOCK, TRAVIS (EMT)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:BOSTOCK
Suffix:
Gender:
Credentials:EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 W CLAY ST # 6876
Mailing Address - Street 2:
Mailing Address - City:ONEILL
Mailing Address - State:NE
Mailing Address - Zip Code:68763-1227
Mailing Address - Country:US
Mailing Address - Phone:402-322-0347
Mailing Address - Fax:
Practice Address - Street 1:106 N 5TH ST
Practice Address - Street 2:
Practice Address - City:PAGE
Practice Address - State:NE
Practice Address - Zip Code:68766-5018
Practice Address - Country:US
Practice Address - Phone:402-338-5901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE24699207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services