MEDICARE: REVIVE HIVE COVID-19 RAPID TESTING CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	163WW0000X	Wound Care Registered Nurse
2	208600000X	Surgery Physician
3	363LF0000X	Family Nurse Practitioner
4	363L00000X	Nurse Practitioner
5	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1255916987
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REVIVE HIVE COVID-19 RAPID TESTING CENTER

Provider Business Mailing Address
First Line	:	4700 S MCCLINTOCK DR STE 140
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-7375
Country	:	US
Telephone Number	:	480-851-6309
Fax Number	:

Provider Business Practice Location Address
First Line	:	4700 S MCCLINTOCK DR STE 140
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-7375
Country	:	US
Telephone Number	:	480-851-6309
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	MICAH PHILIPS
Credential	:
Telephone Number	:	602-717-8599

Provider Enumeration Date	:	03/15/2021
Last Update Date	:	01/13/2026

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