Revive Medical LLC

NPI #1669087045 in Bolivar, Missouri

Provider Information

NPI Number: 1669087045
Entity Type: Organization
Organization Name: Revive Medical LLC
Primary Specialty: Medical Foods Supplier
Enumeration Date: Sep 11, 2020
Last Updated: Sep 11, 2020

Practice Location

Address: 5000
Address 2: S SCENIC
City: Bolivar
State: Missouri
ZIP Code: 65613
Phone: (417) 777-0797

Authorized Official

Name: MR. TROY MORRISON
Title: OWNER
Phone: (417) 777-0797

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Durable Medical Equipment & Medical Supplies - Parenteral & Enteral Nutrition — Parenteral & Enteral Nutrition	332BP3500X
Medical Foods Supplier	335G00000X	Primary

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