Organization
REVOLUTION HEALTH & WELLNESS CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHAD PRESTON EDWARDS D.O. (PHYSICIAN/OWNER)
(918) 935-3636
Entity
Organization
Contact information
Practice address
12142 S YUKON AVE, GLENPOOL, OK 74033-6621
(918) 935-3636
(918) 935-3635
Mailing address
2865 E SKELLY DR STE 300, TULSA, OK 74105-6233
(918) 935-3636
(918) 935-3635
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4353
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1790833481
PERSONAL NPI NUMBER
OK
Enumeration date
12/05/2012
Last updated
02/22/2021
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