# REVIVE MEDICAL CENTER LLC

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

## Provider details

- **NPI number:** 1740996636
- **Authorized official:** LARRY JAKE PICKENS (OWNER/PRESIDENT)
- **Authorized official phone:** (205) 485-7822

## Contact information

- **Practice address:** 1728 11TH AVE, HALEYVILLE, AL 35565-1506
- **Practice address phone:** (205) 485-7822
- **Practice address fax:** (260) 399-4004
- **Mailing address:** PO BOX 1016, HALEYVILLE, AL 35565-1016
- **Mailing address phone:** (205) 485-7822
- **Mailing address fax:** (260) 399-4004

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 261QU0200X | Urgent Care Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 01/25/2023
- **Last updated:** 02/22/2023