NPIMap

Organization Active NPI

Revital LLC

  • Internal Medicine Physician
  • Festus, MO
National Provider Identifier
1518320589
Registry record updated Mar 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
REVITAL LLC
Practice address
101 Main St
Suite 2300 B
Festus, MO 63028-1977
Phone
(314) 254-2420
Fax
(636) 933-9177
NPI assigned
Mar 29, 2016
Last updated
Mar 29, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2016

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

Authorized official

Name
Kevin Meuret
Title
Owner/Ceo
Phone
(314) 254-2420

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

101 Main St
Suite 2300 B
Festus, MO 63028-1977

Mailing address

101 Main St
Suite 2300 B
Festus, MO 63028-1977
Phone (314) 254-2420

National Provider Directory

National Provider Directory
Tax ID family
Revital LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

101 Main St
Ste 2300B
Festus, MO 63028
Phone (314) 254-2420

NPI Registry JSON

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

{
    "created_epoch": "1459209600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459209600000",
    "number": "1518320589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 MAIN ST",
            "address_2": "SUITE 2300 B",
            "city": "FESTUS",
            "state": "MO",
            "postal_code": "630281977",
            "telephone_number": "314-254-2420",
            "fax_number": "636-933-9177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 MAIN ST",
            "address_2": "SUITE 2300 B",
            "city": "FESTUS",
            "state": "MO",
            "postal_code": "630281977",
            "telephone_number": "314-254-2420",
            "fax_number": "636-933-9177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVITAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-29",
        "last_updated": "2016-03-29",
        "status": "A",
        "authorized_official_last_name": "MEURET",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "314-254-2420"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Festus, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2016; 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.