Healthcare Provider Details

I. General information

NPI: 1215829221
Provider Name (Legal Business Name): RAVEN MSO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 BAILEY CIR
PAPILLION NE
68046-4352
US

IV. Provider business mailing address

639 BAILEY CIR
PAPILLION NE
68046-4352
US

V. Phone/Fax

Practice location:
  • Phone: 480-296-8847
  • Fax:
Mailing address:
  • Phone: 480-296-8847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TODD CAZE II
Title or Position: OWNER/CEO
Credential: PHD
Phone: 480-296-8847