Organization
REVOLUTION MEDICAL CENTER, INC
Active
Parent organization
REVOLUTION MEDICAL CENTER, INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
REVOLUTION MEDICAL CENTER, INC
Authorized official
DR. JESSE SAGE HAGGARD N.M.D. (CLINIC DIRECTOR)
(602) 463-7177
Entity
Organization
Contact information
Practice address
2015 E CAMELBACK RD, PHOENIX, AZ 85016-4710
(602) 840-4400
(602) 840-0490
Mailing address
2015 E CAMELBACK RD, PHOENIX, AZ 85016-4710
(602) 840-4400
(602) 840-0490
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
04836D
AZ
Other
Enumeration date
12/21/2007
Last updated
12/21/2007
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