Healthcare Provider Details

I. General information

NPI: 1013483486
Provider Name (Legal Business Name): REVIDA RECOVERY CENTERS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2018
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 VALLEY ST NE
ABINGDON VA
24210-2912
US

IV. Provider business mailing address

3322 W END AVE STE 350
NASHVILLE TN
37203-6911
US

V. Phone/Fax

Practice location:
  • Phone: 276-206-8197
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW THOMAS
Title or Position: CEO
Credential: DO
Phone: 423-631-0432