Revival Medical Weight Loss Clinic

Primary specialty

Obesity Medicine (Preventive Medicine) PhysicianTaxonomy code 2083B0002X

Legal business name

REVIVAL MEDICAL WEIGHT LOSS CLINIC

Practice address

1508 Military Cutoff Rd Ste 203
Wilmington, NC 28403-5730

Phone

(910) 679-4312

NPI assigned

Jan 15, 2021

Organization subpart

No

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

Authorized official

Name

Amy Nealey Wainwright

Title

Ceo

Phone

(910) 679-4312

Specialties & licenses 1

Addresses

Electronic endpoints 1

Tax ID family

Revival Medical Weight Loss Clinic2 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.

• Revival Medical Weight Loss Clinic

  • Obesity Medicine (Preventive Medicine) Physician
  • Greenville, NC
  • NPI 1023785714
  NPD tax ID

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

{
    "created_epoch": "1610668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610668800000",
    "number": "1689263345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1508 MILITARY CUTOFF RD STE 203",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284035730",
            "telephone_number": "910-679-4312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1508 MILITARY CUTOFF RD STE 203",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284035730",
            "telephone_number": "910-679-4312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVAL MEDICAL WEIGHT LOSS CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-15",
        "last_updated": "2021-01-15",
        "certification_date": "2021-01-15",
        "status": "A",
        "authorized_official_last_name": "WAINWRIGHT",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "NEALEY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "910-679-4312"
    },
    "taxonomies": [
        {
            "code": "2083B0002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Obesity Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "a.nealey@direct.rmwl.org",
            "affiliation": "N",
            "endpointDescription": "Direct Messaging",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1508 Military Cutoff Rd Ste 203",
            "city": "Wilmington",
            "state": "NC",
            "country_code": "US",
            "postal_code": "284035730",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Anna Elizabeth Respess, LCSW, CCS
• Restored Wellness & Recovery, PLLC
• Retina of Coastal Carolina, PLLC
• Jordyn Kaylee Reuter
• Revival Medical Group
• Revive Wellness Center
• Revivify Chiropractic Wellness Center
• Karen Rey, FNP-BC
• Kimberly Marie Rey, LCSWA
• Maria Antonia Reyes Tadeo, LMBT

• Obesity Medicine (Preventive Medicine) Physician in Wilmington, NC
• Providers in Wilmington, NC by specialty
• Obesity Medicine (Preventive Medicine) Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 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.