Basic Information
| Provider Information | |||||||||
| NPI: | 1699926758 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EAST CENTRAL DISTRICT HEALTH DEPARTMENT REPRODUCTIVE HEALTH CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2282 EAST 32ND AVE | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025629000 | ||||||||
| FaxNumber: | 4025640611 | ||||||||
| Practice Location | |||||||||
| Address1: | 2282 EAST 32ND AVE | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025629000 | ||||||||
| FaxNumber: | 4025640611 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2008 | ||||||||
| LastUpdateDate: | 10/08/2008 | ||||||||
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| AuthorizedOfficialLastName: | RAYMAN | ||||||||
| AuthorizedOfficialFirstName: | REBECCA | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4025639224 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | EAST CENTRAL DISTRICT HEALTH DEPARTMENT | ||||||||
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| AuthorizedOfficialCredential: | BSN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 16375 | NE | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 363LA2200X | 110277 | NE | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LW0102X | 110667 | NE | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health | 183500000X | 11017 | NE | Y | 193200000X MULTI-SPECIALTY GROUP | Pharmacy Service Providers | Pharmacist |
No ID Information.