| Revivify Health | |
|
615 W Oak St Rogers AR 72756-5315 | |
| (479) 879-3019 | |
| (479) 372-6609 |
| Full Name | Revivify Health |
|---|---|
| Speciality | Clinic/center |
| Location | 615 W Oak St, Rogers, Arkansas |
| Authorized Official Name and Position | Shirranna Todd (PRESIDENT) |
| Authorized Official Contact | 4793018829 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Revivify Health 615 W Oak St Rogers AR 72756-5315 Ph: (479) 879-3019 | Revivify Health 615 W Oak St Rogers AR 72756-5315 Ph: (479) 879-3019 |
| NPI Number | 1548740749 |
|---|---|
| Provider Enumeration Date | 08/16/2018 |
| Last Update Date | 08/16/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548740749 | NPI | - | NPPES |
| 1265413629 | Medicaid | ND |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 11106 (North Dakota) | Primary |
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