I-REVIVE PLLC NPI 1508473000

NPI Information

  • NPI: 1508473000
  • Provider Name: I-REVIVE PLLC
  • Classification: Preventive Medicine - 2083P0500X
  • Specialization: Preventive Medicine/Occupational Environmental Medicine
  • Entity Type: Organization
  • Doing Business As: MY MEDICAL MASSAGE
  • Address: 525 ELLIOTT AVE
    GRAND HAVEN, MI
    ZIP 49417
  • Phone: (616) 566-1603

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NPI Details

I-REVIVE PLLC is a preventive medicine/occupational environmental medicine preventive medicine in Grand Haven, MI. The provider is a preventive medicine physician who specializes in preventive medicine/occupational-environmental medicine, which is focused on protecting the population from occupational and environmental conditions. I-REVIVE PLLC NPI is 1508473000. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As My Medical Massage.

The provider's business location address is:

525 ELLIOTT AVE
GRAND HAVEN, MI
ZIP 49417-038
Phone: (616) 566-1603
Fax: (616) 607-8588

The provider's authorized official is Amanda M Converse .
The authorized official title is Ceo/founder and has the following contact phone number (616) 377-8893.

The enumeration date for this NPI number is 9/28/2020 and was last updated on 11/5/2020.

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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12083P0500XPreventive MedicinePreventive Medicine/Occupational Environmental MedicineYes
2251E00000XHome HealthNo

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 Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
114997664OTHERMICHIGANCAQH

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: 11/21/2025

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