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General NPI Number Information
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NPI Number | 1174137657
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Entity Type | Organization
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Legal Business Name | REVIVAL HEALTH CLINIC
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Dates
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Enumeration Date | 09/02/2020
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Last Update Date | 09/02/2020
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Provider Practice Location Address
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Address Line | 740 W 24TH ST
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City | HOUSTON
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State | TX
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Zip | 77008-1736
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Country | US
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Telephone | 956-222-9375
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Fax |
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Provider Business Mailing Address
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Address Line | 740 W 24TH ST
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City | HOUSTON
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State | TX
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Zip | 77008-1736
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Country | US
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Telephone | 956-222-9375
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MOATH AMRO
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Credential | MD
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Telephone | 956-222-9375
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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