Revive Medical LLC

Primary specialty

Medical Foods SupplierTaxonomy code 335G00000X

Legal business name

REVIVE MEDICAL LLC

Practice address

5000
S Scenic
Bolivar, MO 65613

Phone

(417) 777-0797

NPI assigned

Sep 11, 2020

Organization subpart

No

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

Authorized official

Name

Mr. Troy Morrison

Title

Owner

Phone

(417) 777-0797

Specialties & licenses 2

Addresses

Other names 1

• Ricochet Nutrition Other name

Locations

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

{
    "created_epoch": "1599782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599782400000",
    "number": "1669087045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5000",
            "address_2": "S SCENIC",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "65613",
            "telephone_number": "417-777-0797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5000",
            "address_2": "S SCENIC",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "65613",
            "telephone_number": "417-777-0797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-11",
        "last_updated": "2020-09-11",
        "certification_date": "2020-09-11",
        "status": "A",
        "authorized_official_last_name": "MORRISON",
        "authorized_official_first_name": "TROY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "417-777-0797",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "335G00000X",
            "taxonomy_group": "",
            "desc": "Medical Foods Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ricochet Nutrition",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Richard G. Reber, M.D.
• Lanie Rae Redd
• Regional Foot and Ankle, LLC
• Renal Care Group of the Ozarks, LLC (Renal Care Group Bolivar)
• Revive Health Spa LLC
• Haris Riaz, M.D.
• Michelle K Rieck, NHA CPH
• Joyce Dianne Ries, LCSW
• Kelly Rinker, SLP
• Kimberly A Robertson, LCSW

• Medical Foods Supplier in Bolivar, MO
• Providers in Bolivar, MO by specialty
• Medical Foods Supplier in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2020; 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.