Revitalize Pain and Spine LLC

Primary specialty

Pain Medicine PhysicianTaxonomy code 208VP0000X

Legal business name

REVITALIZE PAIN AND SPINE LLC

Practice address

4838 E Baseline Rd Ste 110
Mesa, AZ 85206-4674

Phone

(480) 210-2641

Fax

(480) 210-2642

NPI assigned

Oct 14, 2020

Last updated

Oct 14, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Amy Williams

Title

Director

Phone

(480) 969-4040

Specialties & licenses 5

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• David A Warkentin, DC

  • Chiropractor
  • Mesa, AZ
  • NPI 1164590006
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1602633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602633600000",
    "number": "1346848090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4838 E BASELINE RD STE 110",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852064674",
            "telephone_number": "480-210-2641",
            "fax_number": "480-210-2642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4838 E BASELINE RD STE 110",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852064674",
            "telephone_number": "480-210-2641",
            "fax_number": "480-210-2642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVITALIZE PAIN AND SPINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-14",
        "last_updated": "2020-10-14",
        "certification_date": "2020-10-14",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "480-969-4040"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Revival Psychiatry and Ketamine Clinic
• Revive Recovery Center LLC
• Revive Recovery Center LLC
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• Pain Medicine Physician in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Pain Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.