| Revive Medical Center Llc | |
|
1728 11th Ave Haleyville AL 35565-1506 | |
| (205) 485-7822 | |
| (260) 399-4004 |
| Full Name | Revive Medical Center Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1728 11th Ave, Haleyville, Alabama |
| Authorized Official Name and Position | Larry Jake Pickens (OWNER/PRESIDENT) |
| Authorized Official Contact | 2054857822 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revive Medical Center Llc Po Box 1016 Haleyville AL 35565-1016 Ph: (205) 485-7822 | Revive Medical Center Llc 1728 11th Ave Haleyville AL 35565-1506 Ph: (205) 485-7822 |
| NPI Number | 1740996636 |
|---|---|
| Provider Enumeration Date | 01/25/2023 |
| Last Update Date | 02/22/2023 |
| Medicare PECOS PAC ID | 3678947793 |
|---|---|
| Medicare Enrollment ID | O20230313001344 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740996636 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 261QU0200X | Clinic/center - Urgent Care | (* (Not Available)) | Secondary |
| Provider Name | Chenyi J Chenyi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922387299 PECOS PAC ID: 2264651561 Enrollment ID: I20140918002190 |
| Provider Name | Amy M Traylor |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972000149 PECOS PAC ID: 5890050447 Enrollment ID: I20210706003625 |
| Provider Name | Dillon Michael Tate |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730874249 PECOS PAC ID: 5395190326 Enrollment ID: I20231011003619 |
| Provider Name | Jake Pickens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770351769 PECOS PAC ID: 9931573052 Enrollment ID: I20240328000674 |
Haleyville Medical Associates Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 42320 Hwy 195, Haleyville, AL 35565 Phone: 205-486-8899 Fax: 205-486-8908 | |
Internal Medicine Associates Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 42030 Highway 195, Suite D, Haleyville, AL 35565 Phone: 615-372-8500 | |
Bankhead Family Medicine Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 42030 Highway 195 Ste A, Haleyville, AL 35565 Phone: 205-485-7219 Fax: 205-485-7135 | |
Lakeland Community Hospital Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 42030 Highway 195 Ste E, Haleyville, AL 35565 Phone: 205-485-7188 | |
Boyde J. Harrison, Md Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 904 26th St, Haleyville, AL 35565 Phone: 205-486-5234 | |
Amy Traylor Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 55 Garden Ln, Haleyville, AL 35565 Phone: 256-749-1739 | |
Lakeland Family Practice Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 42030 Highway 195, Suite D, Haleyville, AL 35565 Phone: 205-485-7243 |