Organization
REVIVE INFUSION CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL JOSEPH SHANNON RN (OWNER)
(417) 793-3935
Entity
Organization
Contact information
Practice address
19332 WAR ADMIRAL RD, EAGLE RIVER, AK 99577-8482
(417) 793-3935
Mailing address
19332 WAR ADMIRAL RD, EAGLE RIVER, AK 99577-8482
(417) 793-3935
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
—
—
261QI0500X
Infusion Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
10/07/2025
Last updated
11/19/2025
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