MEDICARE: REVOLUTION ACCESS LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1427989565
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REVOLUTION ACCESS LLC

Provider Business Mailing Address
First Line	:	9495 WINNETKA AVE N STE 200
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55445-1706
Country	:	US
Telephone Number	:	763-255-3800
Fax Number	:	763-255-3900

Provider Business Practice Location Address
First Line	:	6541 MERIDIEN DR STE 113
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27616-3211
Country	:	US
Telephone Number	:	984-375-8600
Fax Number	:	866-554-5275

Authorized Official
Title or Position	:	SENIOR DIRECTOR
Name	:	KILEY ANN RUSSELL
Credential	:
Telephone Number	:	629-252-8211

Provider Enumeration Date	:	05/27/2026
Last Update Date	:	05/28/2026

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