Healthcare Provider Details

I. General information

NPI: 1780339663
Provider Name (Legal Business Name): REVIVE HEALTHCARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2022
Last Update Date: 02/18/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 HILLCREST DR
HIGH POINT NC
27262-3037
US

IV. Provider business mailing address

REVIVE HEALTHCARE PC 265 EASTCHESTER DRIVE, SUITE 133, # 173
HIGH POINT NC
27262
US

V. Phone/Fax

Practice location:
  • Phone: 336-687-4382
  • Fax:
Mailing address:
  • Phone: 336-687-4382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LAWRENCE ANDREW ESKEW
Title or Position: CEO AND CMO
Credential: MD
Phone: 336-687-4382