Revive Infusion Clinic, LLC

Primary specialty

Infusion Therapy Clinic/CenterTaxonomy code 261QI0500X

Legal business name

REVIVE INFUSION CLINIC, LLC

Practice address

19332 War Admiral Rd
Eagle River, AK 99577-8482

Phone

(417) 793-3935

NPI assigned

Oct 7, 2025

Last updated

Nov 19, 2025By 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

Mr. Michael Joseph Shannon, RNNPI 1871105213

Title

Owner

Phone

(417) 793-3935

Specialties & licenses 2

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.

• Michael Shannon, LPN

  • Licensed Practical Nurse
  • Anchorage, AK
  • NPI 1871105213
  NPD Authorized official

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

{
    "created_epoch": "1759795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763510400000",
    "number": "1457226789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19332 WAR ADMIRAL RD",
            "city": "EAGLE RIVER",
            "state": "AK",
            "postal_code": "995778482",
            "telephone_number": "417-793-3935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19332 WAR ADMIRAL RD",
            "city": "EAGLE RIVER",
            "state": "AK",
            "postal_code": "995778482",
            "telephone_number": "417-793-3935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE INFUSION CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-10-07",
        "last_updated": "2025-11-19",
        "certification_date": "2025-11-19",
        "status": "A",
        "authorized_official_last_name": "SHANNON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "417-793-3935",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Trudy Reder, M.S.,L.P.C.
• Christopher Thomas Reed, DPT
• Laura T Regan, PT, DPT
• Elizabeth Reiland, LPC
• Christopher Reintsma, BA PSYCHOLOGY, CDC1
• Alexis Reyes
• Clayton Reyes
• Jordann Marie Reynolds, LCSW
• Emily Katherine Rhodes, LPTA
• Jenna Christine Rhodes, BHS BCABA

• Infusion Therapy Clinic/Center in Eagle River, AK
• Providers in Eagle River, AK by specialty
• Infusion Therapy Clinic/Center in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2025; 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.