=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780339663
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REVIVE HEALTHCARE PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2022
-----------------------------------------------------
Last Update Date | 02/18/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 221 HILLCREST DR
-----------------------------------------------------
City | HIGH POINT
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27262-3037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-687-4382
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | REVIVE HEALTHCARE PC 265 EASTCHESTER DRIVE, SUITE 133, # 173
-----------------------------------------------------
City | HIGH POINT
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-687-4382
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO AND CMO
-----------------------------------------------------
Name | DR. LAWRENCE ANDREW ESKEW
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 336-687-4382
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------