Revitalize Medical Supply

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

REVITALIZE MEDICAL SUPPLY

Practice address

1680 Elk Creek Dr # 2
Idaho Falls, ID 83404-1225

Phone

(208) 757-4325

NPI assigned

Aug 30, 2021

Organization subpart

No

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

Authorized official

Name

Whitney Whitworth

Title

Owner

Phone

(208) 589-0821

Specialties & licenses 1

Addresses

Other names 1

• Healix Diagnostics Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1630281600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737072000000",
    "number": "1508533209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4954 E POWERHOUSE DR",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834065064",
            "telephone_number": "208-589-0821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1680 ELK CREEK DR # 2",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834041225",
            "telephone_number": "208-757-4325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVITALIZE MEDICAL SUPPLY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-30",
        "last_updated": "2025-01-17",
        "certification_date": "2025-01-17",
        "status": "A",
        "authorized_official_last_name": "WHITWORTH",
        "authorized_official_first_name": "WHITNEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-589-0821"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "whitwhit@isu.edu",
            "affiliation": "N",
            "address_1": "4954 E Powerhouse Dr",
            "city": "Idaho Falls",
            "state": "ID",
            "country_code": "US",
            "postal_code": "834065064",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Healix Diagnostics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mark B Rencher, MD
• Nathan S Rencher, D.O.
• Renewed Foundations LLC
• James Resare, LPC
• Restoration Mental Health
• Michael Rex, LCSW
• Fernando Reyna
• Bradley Lynn Rhinehart, O.D.
• Mehak Riaz, MD
• Danielle Jean Rice

• Clinical Medical Laboratory in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Clinical Medical Laboratory in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.