NPIMap

Organization Active NPI

Revolution Health Medical Center

  • Clinic/Center
  • Phoenix, AZ
National Provider Identifier
1942671060
Registry record updated Oct 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
15-1501 Issued in AZ
Legal business name
REVOLUTION HEALTH MEDICAL CENTER
Practice address
1641 E Osborn Rd
Suite 6
Phoenix, AZ 85016-7146
Phone
(602) 265-1774
Fax
(602) 265-1738
NPI assigned
Oct 15, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2015

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

Authorized official

Name
Dr. Julie Gorman, N.M.D
Title
Ceo
Phone
(602) 265-1774

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 15-1501 AZ Primary

Addresses

Primary practice location

1641 E Osborn Rd
Suite 6
Phoenix, AZ 85016-7146

Mailing address

1641 E Osborn Rd
Suite 6
Phoenix, AZ 85016-7146
Phone (602) 265-1774

National Provider Directory

National Provider Directory
Tax ID family
Revolution Health Medical Center2 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.

NPI Registry JSON

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

{
    "created_epoch": "1444867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444867200000",
    "number": "1942671060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1641 E OSBORN RD",
            "address_2": "SUITE 6",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850167146",
            "telephone_number": "602-265-1774",
            "fax_number": "602-265-1738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1641 E OSBORN RD",
            "address_2": "SUITE 6",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850167146",
            "telephone_number": "602-265-1774",
            "fax_number": "602-265-1738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVOLUTION HEALTH MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-15",
        "last_updated": "2015-10-15",
        "status": "A",
        "authorized_official_last_name": "GORMAN",
        "authorized_official_first_name": "JULIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "602-265-1774",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "N.M.D"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "AZ",
            "license": "15-1501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2015; 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.