REVIVE MEDICAL PLLC NPI 1679239180

NPI Information

NPI: 1679239180
Provider Name: REVIVE MEDICAL, PLLC
Classification: Clinic/Center - 261QE0002X
Entity Type: Organization

Specialization: Emergency Care

CLIA Number: 45D2196247

Address:
12285 PELLICANO DRIVE
SUITE A2
EL PASO, TX
ZIP 79936
Phone: (915) 248-4863
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REVIVE MEDICAL, PLLC is an emergency care clinic center in El Paso, TX. REVIVE MEDICAL, PLLC NPI is 1679239180. The provider is registered as an organization entity type.

The provider's business location address is:

12285 PELLICANO DRIVE
SUITE A2
EL PASO, TX
ZIP 79936
Phone: (915) 248-4863
Fax: (855) 891-7827

The provider's authorized official is Clifford Owen Janke .
The authorized official title is Medical Director and has the following contact phone number (915) 248-4863.

The CLIA number assigned to this NPI record is 45D2196247 - other - texas licensed als fro with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/10/2021 and was last updated on 12/15/2021.

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	Primary
1	251F00000X	Home Infusion		No
2	261QE0002X	Clinic/Center	Emergency Care	Yes
3	261QI0500X	Clinic/Center	Infusion Therapy	No
4	291U00000X	Clinical Medical Laboratory		No
5	3416L0300X	Ambulance	Land Transport	No
6	343900000X	Non-emergency Medical Transport (VAN)		No
7	363LX0106X	Nurse Practitioner	Occupational Health	No
8	333300000X	Emergency Response System Companies		No
9	251S00000X	Community/Behavioral Health		No

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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