Healthcare Provider Details

I. General information

NPI: 1649199829
Provider Name (Legal Business Name): REVIVE PCMS AUSTIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1295 S HIGHWAY 183 STE 101
LEANDER TX
78641-4557
US

IV. Provider business mailing address

1295 S HIGHWAY 183 STE 101
LEANDER TX
78641-4557
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 Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ALI ALHELEJI
Title or Position: CEO
Credential:
Phone: 469-363-3157