Provider Demographics
NPI:1083676860
Name:CITY OF RAVENNA
Entity Type:Organization
Organization Name:CITY OF RAVENNA
Other - Org Name:RAVENNA EMERGENCY UNIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CAPTAIN
Authorized Official - Prefix:MRS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:
Authorized Official - Last Name:DETHLEFS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-379-3107
Mailing Address - Street 1:10802 FARNAM DR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-3237
Mailing Address - Country:US
Mailing Address - Phone:531-895-5853
Mailing Address - Fax:877-343-0131
Practice Address - Street 1:224 ALBA AVE
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:NE
Practice Address - Zip Code:68869-1304
Practice Address - Country:US
Practice Address - Phone:877-218-4392
Practice Address - Fax:877-343-0131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE51073416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE09360OtherBLUE CROSS BLUE SHIELD
NE=========00Medicaid
NE=========00Medicaid