REVIVE MEDICAL LLC (NPI# 1669087045) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669087045 |
| Entity Type | Organization |
| Organization Name | REVIVE MEDICAL LLC |
| Practice Address |
5000 S Scenic Bolivar MO 65613 |
| Practice Telephone | 4177770797 |
| Mailing Telephone | 4177770797 |
| Enumeration Date | 2020-09-11 |
| Last Update Date | 2020-09-11 |
| Authorized Official Name | MR. TROY MORRISON (OWNER) |
| Authorized Official Telephone | 4177770797 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332BP3500X |
Durable Medical Equipment & Medical Supplies Specialization: Parenteral & Enteral Nutrition |
Suppliers | ||
| Y | 335G00000X | Medical Foods Supplier | Suppliers |
| Other Name | Type Code |
|---|---|
| Ricochet Nutrition | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528578499 | Revive Medical LLC | General Practice | 4215 N Classen Blvd Ste 103, Oklahoma City, OK 73118 | 2017-10-05 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Colorado Business Entities | Revive Medical LLC | 5582 Timeless View, Colorado Springs, CO 80915 |
| Street Address |
5000 S SCENIC |
| City | BOLIVAR |
| State | MO |
| Zip Code | 65613 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891301552 | Casablanca Care Center, LLC | Home Health | 524 S. Albany Avenue, Bolivar, MO 65613 | 2020-09-18 |
| 1669097119 | Melanie Nicole Beckham | Nurse Practitioner | 1100 South Springfield Ave, Suite B, Bolivar, MO 65613 | 2020-06-10 |
| 1932754744 | Caitlin M Williams | Specialist/Technologist | 1260 S Pike Avenue, Bolivar, MO 65613 | 2019-08-08 |
| 1073022406 | Jacquelyn Rose Kemnic | Dietitian, Registered | Heart Center, 1500 N Oakland Ave, Willard, MO 65613 | 2017-09-28 |
| 1164897161 | Ozarks Resource Group | Clinic/Center | 203 E. Broadway St., Bolivar, MO 65613 | 2015-12-02 |
| 1962895292 | Professional Christian Counseling | Counselor | 4888 S 139th Road, Bolivar, MO 65613 | 2015-03-11 |
| 1073916573 | Scott Leslie Dennis | Physician Assistant | 1500 North Oakland Ave, Citizens Memorial Hospital, Bolivar, MO 65613 | 2014-09-29 |
| 1053712109 | Citizens Memorial Hospital District | Pharmacy | 1301-b North Oakland, Bolivar, MO 65613 | 2014-09-09 |
| 1740680453 | Jamee M Stimpson | Occupational Therapist | 454 S. Main Avenue, Bolivar, MO 65613 | 2014-08-29 |
| 1154761948 | Motor Monkeys LLC | Occupational Therapist | 454 S Main Ave, Bolivar, MO 65613 | 2013-06-26 |
| Find all providers in zip 65613 | ||||
| Taxonomy Code | 335G00000X |
| Grouping | Suppliers |
| Classification | Medical Foods Supplier |
| A supplier of special replacement foods for clients with errors of metabolism that prohibit them from eating a regular diet. Medical foods are lacking in the compounds which cause complications of the metabolic disorder, and are not generally available in grocery stores, health food stores, or pharmacies. |
| Notes: Source: The Children with Special Healthcare Needs (CSHCN) Services Program, a program of the Texas Department of State Health Services |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144505447 | Si03, Inc. | Medical Foods Supplier | 4711 Nash Road, Scott City, MO 63780 | 2011-10-18 |
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.