Healthcare Provider Details

I. General information

NPI: 1689555930
Provider Name (Legal Business Name): REVIVE PCMS FRISCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2025
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 UNIVERSITY DR STE 240
FRISCO TX
75033-4801
US

IV. Provider business mailing address

2115 UNIVERSITY DR STE 240
FRISCO TX
75033-4801
US

V. Phone/Fax

Practice location:
  • Phone: 972-236-7060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: ALI ALHELEJI
Title or Position: CEO/OWNER
Credential:
Phone: 972-230-7060