# REVIVED MEDICAL COMMUNITY CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306653688
- **Authorized official:** LAVANDA MARTIN APRN (CEO,OWNER)
- **Authorized official phone:** (843) 799-2649

## Contact information

- **Practice address:** 2724 W PALMETTO ST STE 5, FLORENCE, SC 29501-4909
- **Practice address phone:** (843) 799-2649
- **Mailing address:** 2724 W PALMETTO ST STE 5, FLORENCE, SC 29501-4909
- **Mailing address phone:** (843) 799-2649

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 12/11/2024
- **Last updated:** 01/06/2025