Organization
REVAMED CLEWISTON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NATHALIE BASTIEN-MONTPEIROUS M.D. (MEDICAL DIRECTOR)
(863) 983-5453
Entity
Organization
Contact information
Practice address
406 S DEANE DUFF AVE, CLEWISTON, FL 33440-3818
(863) 983-5453
Mailing address
406 S DEANE DUFF AVE, CLEWISTON, FL 33440-3818
(863) 983-5453
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
013400900
—
FL
01
—
1598062630
NPI
—
Enumeration date
05/19/2025
Last updated
05/19/2025
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