MEDICARE: REVIVE GLOBAL PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207RA0201X	Allergy & Immunology (Internal Medicine) Physician
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician
3	207RS0012X	Sleep Medicine (Internal Medicine) Physician
4	207RP1001X	Pulmonary Disease Physician

General Provider Information

NPI Number	:	1497576219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REVIVE GLOBAL PLLC

Provider Business Mailing Address
First Line	:	5539 N MESA ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-5422
Country	:	US
Telephone Number	:	915-213-0900
Fax Number	:	915-271-4145

Provider Business Practice Location Address
First Line	:	5539 N MESA ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-5422
Country	:	US
Telephone Number	:	915-213-0900
Fax Number	:	915-271-4145

Authorized Official
Title or Position	:	PRESIDENT
Name	:	FAHAD OMAR
Credential	:	MD
Telephone Number	:	915-213-0900

Provider Enumeration Date	:	10/23/2024
Last Update Date	:	10/23/2024

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