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Organization
REVIVE MEDICAL LLC
Active
Organization
REVIVE MEDICAL LLC
Active
Other names
Ricochet Nutrition
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TROY MORRISON (OWNER)
(417) 777-0797
Entity
Organization
Contact information
Practice address
5000, S SCENIC, BOLIVAR, MO 65613
(417) 777-0797
Mailing address
5000, S SCENIC, BOLIVAR, MO 65613
(417) 777-0797
Taxonomy
Speciality
Code
Description
License number
State
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
NULL
335G00000X
Medical Foods Supplier
Primary
—
NULL
Other
Enumeration date
09/11/2020
Last updated
09/11/2020
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