Revolutionary Services LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

REVOLUTIONARY SERVICES LLC

Practice address

5130 Hwy 95
Fort Mohave, AZ 86426-9374

Phone

(928) 768-2811

Fax

(928) 768-9787

NPI assigned

Nov 4, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Allen Earl Stout, D.C. F.N.P.-CNPI 1902833817

Title

Manager

Phone

(928) 768-2811

Specialties & licenses 2

Addresses

Other names 1

• Stout Wellness Center Doing business as

Medicare fee-for-service enrollment

Enrolled in AZ

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

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Allen E Stout, DC, FNP

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Fort Mohave, AZ
  • NPI 1902833817
  Medicare reassignment Care Compare group Authorized official
• Terry L Coyle, D.C., F.N.P.

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Fort Mohave, AZ
  • NPI 1639127780
  Medicare reassignment Care Compare group NPD
• Patrick Allan Beck, D.C.

  • Chiropractor
  • Bullhead City, AZ
  • NPI 1811903008
  NPD (past)
• Linda Kay Hadley, APRN FNP

  • Family Nurse Practitioner
  • Kailua, HI
  • NPI 1720282353
  NPD (past)

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

{
    "created_epoch": "1257292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709251200000",
    "number": "1598092082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5130 HWY 95",
            "city": "FORT MOHAVE",
            "state": "AZ",
            "postal_code": "864269374",
            "telephone_number": "928-768-2811",
            "fax_number": "928-768-9787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5130 HWY 95",
            "city": "FORT MOHAVE",
            "state": "AZ",
            "postal_code": "864269374",
            "telephone_number": "928-768-2811",
            "fax_number": "928-768-9787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVOLUTIONARY SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-04",
        "last_updated": "2024-03-01",
        "certification_date": "2024-03-01",
        "status": "A",
        "authorized_official_last_name": "STOUT",
        "authorized_official_first_name": "ALLEN",
        "authorized_official_middle_name": "EARL",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "928-768-2811",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C. F.N.P.-C"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "AZ",
            "license": "7353",
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stout Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Radiologic Associates of Northwest Arizona PLC
• Ramesh C Tandon MD PLLC
• Tasha Ray
• Rejuvenated Health & Wellness
• Revolutionary Services LLC
• Maria Guadalupe Reyes
• Richard E Hendrix, MD Inc
• Ringtail Emergency Physicians
• Urmee Ripon, PHARMD
• Nicole Ann Roberts, FNP

• Multi-Specialty Clinic/Center in Fort Mohave, AZ
• Providers in Fort Mohave, AZ by specialty
• Multi-Specialty Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2024; 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.