Revelation Enterprises Inc

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

License

39 Issued in OK

Legal business name

REVELATION ENTERPRISES INC

Practice address

4521 NW 3Rd St
Oklahoma City, OK 73127-6401

Phone

(405) 319-0685

Fax

(405) 319-0684

NPI assigned

Oct 27, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Anita C Mullin, CMF

Title

Vice President

Phone

(405) 319-0685

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 2

• Rev Pro Inc Prosthetics & Orthotics Doing business as
• Revelation Prosthetics, Inc. Doing business as

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674518400000",
    "number": "1740366210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4521 NW 3RD ST",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731276401",
            "telephone_number": "405-319-0685",
            "fax_number": "405-319-0684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4521 NW 3RD ST",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731276401",
            "telephone_number": "405-319-0685",
            "fax_number": "405-319-0684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVELATION ENTERPRISES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-27",
        "last_updated": "2023-01-24",
        "certification_date": "2023-01-24",
        "status": "A",
        "authorized_official_last_name": "MULLIN",
        "authorized_official_first_name": "ANITA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "405-319-0685",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CMF"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "OK",
            "license": "39",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100812360A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rev Pro Inc Prosthetics & Orthotics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Revelation Prosthetics, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amber N Rettke
• Reuben Thomas O.D., P.L.L.C.
• Cacee Reuben, ATC
• Dayna Joyce Reust, A.P.R.N.
• Frederick Blake Reuter, M.D.
• Revelation Medical of Oklahoma City LLC
• Revitalize Nutrition Corp
• Revitalizing Hope, LLC
• Revive Clinic LLC
• Revive DME

• Prosthetic/Orthotic Supplier in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Prosthetic/Orthotic Supplier in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2023; 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.