REVOLUTIONARY SERVICES LLC NPI 1518082122

NPI Information

REVOLUTIONARY SERVICES LLC is a multi-specialty clinic center in Fort Mohave, AZ. REVOLUTIONARY SERVICES LLC NPI is 1518082122. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Stout Wellness Center.

The provider's business location address is:

5130 S HIGHWAY 95
FORT MOHAVE, AZ
ZIP 86426-374
Phone: (928) 768-2811
Fax: (928) 768-9787

The provider's authorized official is Allen Earl Stout .
The authorized official title is Manager and has the following contact phone number (928) 768-2811.

The CLIA number assigned to this NPI record is 03D2024361 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/20/2007 and was last updated on 3/1/2024.

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:

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