Provider Demographics
NPI:1699926758
Name:EAST CENTRAL DISTRICT HEALTH DEPARTMENT REPRODUCTIVE HEALTH CLINIC
Entity type:Organization
Organization Name:EAST CENTRAL DISTRICT HEALTH DEPARTMENT REPRODUCTIVE HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:J
Authorized Official - Last Name:RAYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:402-563-9224
Mailing Address - Street 1:2282 EAST 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601
Mailing Address - Country:US
Mailing Address - Phone:402-562-9000
Mailing Address - Fax:402-564-0611
Practice Address - Street 1:2282 EAST 32ND AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601
Practice Address - Country:US
Practice Address - Phone:402-562-9000
Practice Address - Fax:402-564-0611
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST CENTRAL DISTRICT HEALTH DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11017183500000X
NE16375207V00000X
NE110277363LA2200X
NE110667363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========00Medicaid
NE=========00Medicaid