Healthcare Provider Details

I. General information

NPI: 1205509619
Provider Name (Legal Business Name): REVIVE INFUSION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 11/06/2021
Certification Date: 11/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6904 SAINT MARYS PL
OKLAHOMA CITY OK
73132-6821
US

IV. Provider business mailing address

6904 SAINT MARYS PL
OKLAHOMA CITY OK
73132-6821
US

V. Phone/Fax

Practice location:
  • Phone: 405-229-9600
  • Fax:
Mailing address:
  • Phone: 405-229-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State

VIII. Authorized Official

Name: MELISA D ALEXANDER
Title or Position: CO OWNER
Credential: RN
Phone: 405-229-9600