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Organization
REVIVE MEDICAL, PLLC
Active
Organization
REVIVE MEDICAL, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLIFFORD OWEN JANKE MD (MEDICAL DIRECTOR)
(915) 248-4863
Entity
Organization
Contact information
Practice address
12285 PELLICANO DRIVE, SUITE A2, EL PASO, TX 79936
(915) 248-4863
(855) 891-7827
Mailing address
12285 PELLICANO DRIVE, SUITE A2, EL PASO, TX 79936
(915) 248-4863
(855) 891-7827
Taxonomy
Speciality
Code
Description
License number
State
251F00000X
Home Infusion Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QE0002X
Emergency Care Clinic/Center
Primary
—
—
261QI0500X
Infusion Therapy Clinic/Center
—
—
291U00000X
Clinical Medical Laboratory
—
—
333300000X
Emergency Response System Companies
—
—
3416L0300X
Land Ambulance
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
363LX0106X
Occupational Health Nurse Practitioner
—
—
Other
Enumeration date
11/10/2021
Last updated
12/15/2021
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