Organization
REVIVE CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMY CARTER (PARTNER)
(405) 392-3300
Entity
Organization
Contact information
Practice address
13316 S WESTERN AVE STE F, OKLAHOMA CITY, OK 73170-7309
(405) 703-8882
(405) 237-3799
Mailing address
13316 S WESTERN AVE STE F, OKLAHOMA CITY, OK 73170-7309
(405) 703-8882
(405) 237-3799
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
03/12/2018
Last updated
03/12/2018
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