NPIMap

Organization Active NPI

Revolution Medical Center, Inc

  • Non-Pharmacy Dispensing Site
  • Phoenix, AZ
National Provider Identifier
1376727610
Registry record updated Dec 21, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
04836D Issued in AZ
Legal business name
REVOLUTION MEDICAL CENTER, INC
Practice address
2015 E Camelback Rd
Phoenix, AZ 85016-4710
Phone
(602) 840-4400
Fax
(602) 840-0490
NPI assigned
Dec 21, 2007
Organization subpart
Yes
Parent organization
REVOLUTION MEDICAL CENTER, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 21, 2007

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

Authorized official

Name
Dr. Jesse Sage Haggard, N.M.D.
Title
Clinic Director
Phone
(602) 463-7177

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X 04836D AZ Primary

Addresses

Primary practice location

2015 E Camelback Rd
Phoenix, AZ 85016-4710

Mailing address

2015 E Camelback Rd
Phoenix, AZ 85016-4710
Phone (602) 840-4400

National Provider Directory

National Provider Directory
Tax ID family
Revolution Medical Center Inc2 organizations share this tax ID, including this one
Part of
Revolution Medical Center Inc

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2015 E Camelback Rd
Phoenix, AZ 85016
Phone (602) 840-4400

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1198195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198195200000",
    "number": "1376727610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2015 E CAMELBACK RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850164710",
            "telephone_number": "602-840-4400",
            "fax_number": "602-840-0490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2015 E CAMELBACK RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850164710",
            "telephone_number": "602-840-4400",
            "fax_number": "602-840-0490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVOLUTION MEDICAL CENTER, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "REVOLUTION MEDICAL CENTER, INC",
        "enumeration_date": "2007-12-21",
        "last_updated": "2007-12-21",
        "status": "A",
        "authorized_official_last_name": "HAGGARD",
        "authorized_official_first_name": "JESSE",
        "authorized_official_middle_name": "SAGE",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "602-463-7177",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "N.M.D."
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "AZ",
            "license": "04836D",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2007; 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.