# JACKSON SURGICAL CONSULTANTS P.A.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Revive Wellness
- **Organization subpart:** No

## Provider details

- **NPI number:** 1326799610
- **Authorized official:** MARISSA DELUNA (CREDENTIALING MANAGER)
- **Authorized official phone:** (713) 800-3359

## Contact information

- **Practice address:** 1110 S FRIENDSWOOD DR, FRIENDSWOOD, TX 77546-5698
- **Practice address phone:** (409) 299-4785
- **Practice address fax:** (409) 220-8348
- **Mailing address:** 12337 JONES RD STE 427, HOUSTON, TX 77070-4951
- **Mailing address phone:** (409) 299-4785
- **Mailing address fax:** (409) 220-8348

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171400000X | Health & Wellness Coach | — | NULL | — |
| 171400000X | Health & Wellness Coach | — | — | — |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/18/2022
- **Last updated:** 02/03/2022