REVIVE MEDICAL LLC (NPI# 1528578499) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528578499 |
| Entity Type | Organization |
| Organization Name | REVIVE MEDICAL LLC |
| Practice Address |
4215 N Classen Blvd Ste 103 Oklahoma City OK 73118 |
| Mailing Address |
4215 N Classen Blvd Ste 103 Oklahoma City OK 73118-2431 |
| Practice Telephone | 9514401652 |
| Mailing Telephone | 4056737856 |
| Enumeration Date | 2017-10-05 |
| Last Update Date | 2018-08-22 |
| Authorized Official Name | KEVIN BROWN (OWNER) |
| Authorized Official Telephone | 4056737856 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669087045 | Revive Medical LLC | Durable Medical Equipment & Medical Supplies | 5000, S Scenic, Bolivar, MO 65613 | 2020-09-11 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Colorado Business Entities | Revive Medical LLC | 5582 Timeless View, Colorado Springs, CO 80915 |
| Street Address |
4215 N CLASSEN BLVD STE 103 |
| City | OKLAHOMA CITY |
| State | OK |
| Zip Code | 73118 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760009229 | Mahla Mohsenzadeh | Chiropractor | 4215 N Classen Blvd Ste 103, Oklahoma City, OK 73118-2426 | 2020-07-01 |
| 1740842327 | Revive Health of Oklahoma LLC | General Practice | 4215 N Classen Blvd Ste 103, Oklahoma City, OK 73118-2426 | 2019-07-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255812772 | Karrie Danea Moreno | Behavior Technician | 1507 Ne 31st, Oklahoma, OK 73118 | 2018-08-23 |
| 1225556228 | Anika Carr | Case Manager/Care Coordinator | 1212 Nw 32nd Street, Oklahoma City, OK 73118 | 2017-08-30 |
| 1740635168 | Nikhil Malhotra | Internal Medicine | 3635 Vista Avenue At Grand Boulevard, 14th Floor, Desloge Towers, St. Louis, MO 73118 | 2016-05-04 |
| 1144694183 | Christopher Woon | Counselor | 4001 N Classen, Suite 105, Oklahoma City, OK 73118 | 2015-11-13 |
| 1699181925 | Stac Embry | Counselor | 3321 N. Mckinley Ave, Oklahoma City, OK 73118 | 2014-07-08 |
| 1194161216 | Jennifer Kaye Powers | Counselor | 3124 N. Classen Blvd., Ste. A, Oklahoma City, OK 73118 | 2013-05-15 |
| 1932445491 | Jessica Camp | Behavioral Analyst | 3220 N Harvey Pkwy, Oklahoma City, OK 73118 | 2013-01-02 |
| 1942578661 | Michael D Danielson | Behavioral Analyst | 4232 N Sante Fe Ave, Oklahoma City, OK 73118 | 2011-12-08 |
| 1912280587 | Tara Roberts | Counselor | 1743 Nw 37th, Oklahoma City, OK 73118 | 2011-09-21 |
| 1790066769 | Jimmy Early Jr. | Counselor | 4801 Nw Classen, Suite #233, Oklahoma City, OK 73118 | 2011-09-06 |
| Find all providers in zip 73118 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669080891 | Prairie Gardens Medical LLC | General Practice | 1213 Nw 122nd St Ste 401, Oklahoma City, OK 73114-7000 | 2020-07-14 |
| 1053875781 | Oumi Clinics LLC | General Practice | 1200 Childrens Ave Ste 11200, Oklahoma City, OK 73104-4637 | 2019-01-28 |
| 1891149647 | Daniel Enriquez | General Practice | 1040 7050 S Air Depot Blvd, Oklahoma City, OK 73135 | 2016-04-18 |
| 1669726188 | Arrrc, Inc. | General Practice | 2149 S.w. 59th St., Suite 105, Oklahoma City, OK 73119-7003 | 2012-11-06 |
| 1386932986 | George Fred Mcdonnold | General Practice | 2973 Rolling Stone Rd, Oklahoma City, OK 73120-1921 | 2011-07-16 |
| 1770877151 | Michael Shane Johnson | General Practice | 13600 Prairie View Ln, Oklahoma City, OK 73142-5917 | 2011-06-03 |
| 1295027647 | Albert T Nguyen | General Practice | 2636 Sw 28th St, Oklahoma City, OK 73108-5823 | 2011-05-04 |
| 1538458047 | Healthfirst Physician Management | General Practice | 1111 N Dewey, Pre-op Clinic, Oklahoma City, OK 73103 | 2011-04-05 |
| 1114154960 | Joshua Alan Stevens | General Practice | 301 Nw 6th St, Ste 150, Oklahoma City, OK 73102-2823 | 2009-06-19 |
| 1629226717 | Family Medical Office, LLC | General Practice | 9220 S Penn Ave, Suite A, Oklahoma City, OK 73159-6937 | 2008-09-03 |
| Find all providers in OKLAHOMA CITY | ||||
| City | OKLAHOMA CITY |
| Zip Code | 73118 |
Please comment or provide details below to improve the information on REVIVE MEDICAL LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.