REVOLUTIONARY SERVICES LLC NPI 1598092082

NPI Information

NPI: 1598092082
Provider Name: REVOLUTIONARY SERVICES LLC

Doing Business As: STOUT WELLNESS CENTER

Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

Address:
5130 HWY 95
FORT MOHAVE, AZ
ZIP 86426
Phone: (928) 768-2811
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REVOLUTIONARY SERVICES LLC is a multi-specialty clinic center in Fort Mohave, AZ. REVOLUTIONARY SERVICES LLC NPI is 1598092082. 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 HWY 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 enumeration date for this NPI number is 11/4/2009 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:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	111N00000X	Chiropractor		7353	ARIZONA	No
2	261QM1300X	Clinic/Center	Multi-Specialty			Yes

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

NPI Synchronization or Removal

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