NPIMap

Organization Active NPI

Revivology

  • Clinic/Center
  • South Jordan, UT
National Provider Identifier
1467988832
Registry record updated May 4, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
9258138-1205 Issued in UT
Legal business name
REVIVOLOGY
Practice address
11464 S Parkway Plaza Dr
Suite 300
South Jordan, UT 84095-6052
Phone
(801) 987-8653
Fax
(801) 727-8177
NPI assigned
May 4, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 4, 2017

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

Authorized official

Name
Dr. Christopher Patrick Kelly, M.D.
Title
Medical Director/Owner
Phone
(801) 987-8653

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 9258138-1205 UT Primary

Addresses

Primary practice location

11464 S Parkway Plaza Dr
Suite 300
South Jordan, UT 84095-6052

Mailing address

11464 S Parkway Plaza Dr
Suite 300
South Jordan, UT 84095-6052
Phone (801) 987-8653

National Provider Directory

National Provider Directory

Locations

11464 S Parkway Plaza Dr
Ste 300
South Jordan, UT 84095
Phone (801) 987-8653

NPI Registry JSON

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

{
    "created_epoch": "1493856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493856000000",
    "number": "1467988832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11464 S PARKWAY PLAZA DR",
            "address_2": "SUITE 300",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840956052",
            "telephone_number": "801-987-8653",
            "fax_number": "801-727-8177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11464 S PARKWAY PLAZA DR",
            "address_2": "SUITE 300",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840956052",
            "telephone_number": "801-987-8653",
            "fax_number": "801-727-8177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-04",
        "last_updated": "2017-05-04",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "PATRICK",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR/OWNER",
        "authorized_official_telephone_number": "801-987-8653",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "UT",
            "license": "9258138-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Jordan, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2017; 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.