Revolution Health & Wellness Clinic PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4353 Issued in OK

Legal business name

REVOLUTION HEALTH & WELLNESS CLINIC PLLC

Practice address

12142 S Yukon Ave
Glenpool, OK 74033-6621

Phone

(918) 935-3636

Fax

(918) 935-3635

NPI assigned

Dec 5, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Chad Preston Edwards, D.O.

Title

Physician/Owner

Phone

(918) 935-3636

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1354665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613952000000",
    "number": "1649515446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2865 E SKELLY DR STE 300",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741056233",
            "telephone_number": "918-935-3636",
            "fax_number": "918-935-3635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12142 S YUKON AVE",
            "city": "GLENPOOL",
            "state": "OK",
            "postal_code": "740336621",
            "telephone_number": "918-935-3636",
            "fax_number": "918-935-3635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVOLUTION HEALTH & WELLNESS CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-05",
        "last_updated": "2021-02-22",
        "certification_date": "2021-02-22",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "CHAD",
        "authorized_official_middle_name": "PRESTON",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "918-935-3636",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "4353",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PERSONAL NPI NUMBER",
            "identifier": "1790833481",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Glenpool, OK
• Providers in Glenpool, OK by specialty
• Family Medicine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2021; 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.