| Revitalize Medical Group, Ltd | |
|
1 Park West Blvd Suite 210 Akron OH 44320-4218 | |
| (330) 493-4443 | |
| Not Available |
| Full Name | Revitalize Medical Group, Ltd |
|---|---|
| Speciality | Obstetrics & Gynecology |
| Location | 1 Park West Blvd, Akron, Ohio |
| Authorized Official Name and Position | David L. Scott (EXECUTIVE LEADER) |
| Authorized Official Contact | 3304934443 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revitalize Medical Group, Ltd 4535 Dressler Rd Nw Canton OH 44718-2545 Ph: (330) 493-4443 | Revitalize Medical Group, Ltd 1 Park West Blvd Suite 210 Akron OH 44320-4218 Ph: (330) 493-4443 |
| NPI Number | 1922443340 |
|---|---|
| Provider Enumeration Date | 04/30/2013 |
| Last Update Date | 05/01/2013 |
| Medicare PECOS PAC ID | 4981845831 |
|---|---|
| Medicare Enrollment ID | O20130719000067 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922443340 | NPI | - | NPPES |
| Provider Name | Victoria L Shaw |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427173582 PECOS PAC ID: 2668500190 Enrollment ID: I20100504000616 |
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