Healthcare Provider Details

I. General information

NPI: 1609974401
Provider Name (Legal Business Name): REVISION TECHNOLOGIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 POLARIS PARKWAY S SUITE 100
COLUMBUS OH
43240
US

IV. Provider business mailing address

1080 POLARIS PARKWAY S SUITE 100
COLUMBUS OH
43240
US

V. Phone/Fax

Practice location:
  • Phone: 614-781-0499
  • Fax: 614-781-1974
Mailing address:
  • Phone: 614-781-0499
  • Fax: 614-781-1974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number0642AS
License Number StateOH

VIII. Authorized Official

Name: MR. DOUGLAS JAMES SCHUMER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 419-525-3737