Organization
RAVENNA MEDICAL CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN LIESKE PA-C (PHYSICIAN ASSISTANT/OWNER)
(308) 452-3203
Entity
Organization
Contact information
Practice address
104 W SENECA ST, RAVENNA, NE 68869
(308) 452-3203
(308) 452-3795
Mailing address
611 W SENECA ST, RAVENNA, NE 68869-1200
(308) 452-3203
(308) 452-3795
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Enumeration date
06/30/2017
Last updated
07/14/2017
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