# REVIVE HEALTH MEDICAL SUPPLIES

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

## Provider details

- **NPI number:** 1992002695
- **Authorized official:** DR. MARTIN JONES DPT (OWNER/PT)
- **Authorized official phone:** (972) 263-7042

## Contact information

- **Practice address:** 504 N CARRIER PKWY, GRAND PRAIRIE, TX 75050-5428
- **Practice address phone:** (972) 263-7042
- **Practice address fax:** (972) 263-7046
- **Mailing address:** PO BOX 92282, SOUTHLAKE, TX 76092-0103
- **Mailing address phone:** (972) 263-7042
- **Mailing address fax:** (972) 263-7046

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | TX | Yes |

## Other

- **Enumeration date:** 02/16/2011
- **Last updated:** 02/16/2011