City of Ravenna
Organization Active NPI Land Ambulance · Ravenna, NE
NPI 1083676860 · NPPES record last updated Aug 14, 2023
Key facts
- NPI
- 1083676860
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Land Ambulance 3416L0300X
- License
- 5107 (NE)
- Legal business name
- CITY OF RAVENNA
- Practice address
- 224 Alba Ave
Ravenna, NE 68869-1304 - Phone
- (877) 218-4392
- Fax
- (877) 343-0131
- NPI assigned
- Apr 5, 2006
- Organization subpart
- No
Authorized official
- Name
- Mrs. Peggy Dethlefs
- Title
- Captain
- Phone
- (308) 379-3107
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 28D1090325 | Ravenna Emergency Unit | Certificate of waiver | Oct 7, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NE
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050805000716 | NE | Part B Supplier - Ambulance Service Supplier | 2466481882 | Practice locations: Ravenna, NE |
National Provider Directory
Locations
224 Alba Ave
Ravenna, NE 68869
Phone (308) 379-3107
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | 5107 | NE | Yes |
Addresses
Primary practice location
224 Alba Ave
Ravenna, NE 68869-1304
Mailing address
10802 Farnam Dr
Omaha, NE 68154-3237
Phone (531) 895-5853
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 09360 | Other | NE | BLUE CROSS BLUE SHIELD |
Other names
- RAVENNA EMERGENCY UNIT
Other providers in Ravenna, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 14, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.