REVIVE HORMONE CLINIC PLLC (NPI# 1912448754) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912448754 |
| Entity Type | Organization |
| Organization Name | REVIVE HORMONE CLINIC PLLC |
| Other Organization Name | REVIVE THERAPY |
| Practice Address |
13316 S Western Ave Suite F Oklahoma City OK 73170-7302 |
| Practice Telephone | 4057038882 |
| Practice Fax Number | 4052373799 |
| Mailing Telephone | 4057038882 |
| Mailing Fax Number | 4052373799 |
| Enumeration Date | 2017-03-13 |
| Last Update Date | 2017-03-13 |
| Authorized Official Name | DR. ERNEST BYRON FOSTER II (MANAGER) |
| Authorized Official Telephone | 4057038882 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QH0100X |
Clinic/Center Specialization: Health Service |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Revive Therapy | Other Name - Individual/Organization |
| Street Address |
13316 S WESTERN AVE SUITE F |
| City | OKLAHOMA CITY |
| State | OK |
| Zip Code | 73170-7302 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679071864 | Keeley Victoria Marie Walker | Nurse Practitioner | 13316 S Western Ave, Oklahoma City, OK 73170-7302 | 2018-01-23 |
| 1457507683 | Mark D. Shirley,dds, PC | Dentist | 13316 S Western Ave, Suite B, Oklahoma City, OK 73170-7302 | 2008-08-07 |
| 1518132018 | Allied Physician's Group Inc PC | Durable Medical Equipment & Medical Supplies | 13316 S Western Ave, Suite M, Oklahoma City, OK 73170-7302 | 2008-04-25 |
| 1215122387 | Cumulative Trauma Treatment Center | Chiropractor | 13316 S Western Ave, Suite Q, Oklahoma City, OK 73170-7302 | 2007-09-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144847542 | Premier Healthcare, Aprn-cnp | Nurse Practitioner | 12208 South Western Avenue, Suite B, Oklahoma City, OK 73170 | 2020-07-01 |
| 1982233565 | Bethany Ann Arthur | Student in an Organized Health Care Education/Training Program | 661 Waterview Rd, Okc, OK 73170 | 2020-04-06 |
| 1952868929 | Ariana N. Ree | Peer Specialist | 328 Sw 147th St, Oklahoma City, OK 73170 | 2019-02-26 |
| 1780151431 | Looking Up Counseling | Counselor | 709 Sw 119th Ste. B1, Okc, OK 73170 | 2018-10-31 |
| 1902385859 | Danell Marie Rahni | Psychologist | 17300 Serrano Dr, Oklahoma City, OK 73170 | 2018-08-11 |
| 1619468378 | Nhan Nguyen | Student in an Organized Health Care Education/Training Program | 10504 S Miller Ave, Oklahoma City, OK 73170 | 2018-05-29 |
| 1740709906 | Hall Podiatry LLC | Clinic/Center | 20 Sw 132nd Terrace, Moore, OK 73170 | 2017-09-19 |
| 1942727896 | Adelaide V South | Dietitian, Registered | 12216 S Land Ave, Oklahoma City, OH 73170 | 2017-08-22 |
| 1477073609 | Mary Ann Hayden | Nurse Practitioner | 3224 Sw 119th Street, Hennessee & Associates, Oklahoma City, OK 73170 | 2017-06-20 |
| 1245762293 | Michael David Detten | Physical Therapist | 10740 S May Ave Ste 111, Oklahoma City, OK 73170 | 2017-03-29 |
| Find all providers in zip 73170 | ||||
| Taxonomy Code | 261QH0100X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Health Service |
| Definition to come... |
| Notes: [7/1/2006: modified title] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164866737 | Vitality Wellness | Clinic/Center | 5740 Nw 135th St., Oklahoma City, OK 73142 | 2013-04-25 |
| 1992008072 | Arthritis & Rheumatology Center of Oklahoma | Clinic/Center | 1111 N Lee Ave Ste 249, Oklahoma City, OK 73103-2600 | 2010-12-13 |
| 1598072050 | Health Watch Medical Center | Clinic/Center | 1924 N Portland Ave, Oklahoma City, OK 73107-1532 | 2010-09-04 |
| 1609821370 | Rhea Health LLC | Clinic/Center | 1421 S Council Rd, Oklahoma City, OK 73128-9504 | 2006-05-23 |
| 1407327851 | Oklahoma Health and Wellness 97 | Clinic/Center | 5700 N Portland Ave Ste 102, Oklahoma City, OK 73112-1662 | 2018-12-11 |
| 1467972729 | Shawnaree L. Lee, Do Pllc | Clinic/Center | 3433 Nw 56th St Ste 210b, Oklahoma City, OK 73112-4445 | 2017-06-27 |
| 1558603738 | Kp Medical Group, LLC | Clinic/Center | 2301 W I 44 Service Rd, Suite 300, Oklahoma City, OK 73112-8729 | 2013-03-26 |
| 1205105780 | Brain & Eye Connection Vision Clinic, PC | Clinic/Center | 1530 Sw 89th St, Ste D2, Oklahoma City, OK 73159-6366 | 2011-12-29 |
| 1639321110 | Concentra Health Services, Inc. | Clinic/Center | 7100 S. I-35 Service Road, Suite 7, Oklahoma City, OK 73149-2740 | 2008-10-16 |
| 1649422122 | Concentra Health Services, Inc. | Clinic/Center | 36 West Memorial Rd., Suite C3, Oklahoma City, OK 73114-2325 | 2008-10-16 |
| Find all providers in OKLAHOMA CITY | ||||
| City | OKLAHOMA CITY |
| Zip Code | 73170 |
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| 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.