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REVISION WELLNESS LLC NPI 1497390702


NPI Information

NPI: 1497390702
Provider Name: REVISION WELLNESS, LLC
Classification: Clinic/Center - 261Q00000X
Entity Type: Organization
Address:
11312 MANKLIN CREEK RD UNIT 5
BERLIN, MD
ZIP 21811
Phone: (443) 513-5000
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REVISION WELLNESS, LLC is a clinic center in Berlin, MD. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). REVISION WELLNESS, LLC NPI is 1497390702. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

11312 MANKLIN CREEK RD UNIT 5
BERLIN, MD
ZIP 21811-009
Phone: (443) 513-5000
Fax: (888) 307-9020

The provider's authorized official is Angela Borrell .
The authorized official title is Owner -clinical Provider and has the following contact phone number (443) 513-0500.

The enumeration date for this NPI number is 11/11/2019 and was last updated on 8/24/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1163WP0808XRegistered NursePsychiatric/Mental HealthNo
22083A0300XPreventive MedicineAddiction MedicineNo
32083B0002XPreventive MedicineObesity MedicineNo
42083P0901XPreventive MedicinePublic Health & General Preventive MedicineNo
5363LF0000XNurse PractitionerFamilyNo
6261Q00000XClinic/CenterYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
11457683740OTHERMARYLANDINDIVIDUAL NPI ASSOCIATED WITH REVISION WELLNESS
2722026000MEDICAIDMARYLAND
31497390702OTHERMARYLANDGROUP NPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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