Revive Clinic LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

REVIVE CLINIC LLC

Practice address

13316 S Western Ave Ste F
Oklahoma City, OK 73170-7309

Phone

(405) 703-8882

Fax

(405) 237-3799

NPI assigned

Mar 12, 2018

Last updated

Mar 12, 2018By 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

Jeremy Carter

Title

Partner

Phone

(405) 392-3300

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1520812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1520812800000",
    "number": "1518460047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13316 S WESTERN AVE STE F",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731707309",
            "telephone_number": "405-703-8882",
            "fax_number": "405-237-3799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13316 S WESTERN AVE STE F",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731707309",
            "telephone_number": "405-703-8882",
            "fax_number": "405-237-3799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-12",
        "last_updated": "2018-03-12",
        "status": "A",
        "authorized_official_last_name": "CARTER",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "405-392-3300"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Frederick Blake Reuter, M.D.
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• Revelation Medical of Oklahoma City LLC
• Revitalize Nutrition Corp (IV Nutrition)
• Revitalizing Hope, LLC
• Revive DME
• Revive Health of Oklahoma LLC (Revive Health Of Oklahoma)
• Revive Health Services
• Revive Hormone Clinic PLLC
• Revive Infusion

• Clinic/Center in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Clinic/Center in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2018; 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.