Organization
REVIVE MEDICAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY JAKE PICKENS (OWNER/PRESIDENT)
(205) 485-7822
Entity
Organization
Contact information
Practice address
1728 11TH AVE, HALEYVILLE, AL 35565-1506
(205) 485-7822
(260) 399-4004
Mailing address
PO BOX 1016, HALEYVILLE, AL 35565-1016
(205) 485-7822
(260) 399-4004
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
261QU0200X
Urgent Care Clinic/Center
—
—
Other
Enumeration date
01/25/2023
Last updated
02/22/2023
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