| Revamed Clewiston | |
|
406 S Deane Duff Ave Clewiston FL 33440-3818 | |
| (863) 983-5453 | |
| Not Available |
| Full Name | Revamed Clewiston |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 406 S Deane Duff Ave, Clewiston, Florida |
| Authorized Official Name and Position | Nathalie Bastien-montpeirous (MEDICAL DIRECTOR) |
| Authorized Official Contact | 8639835453 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Revamed Clewiston 406 S Deane Duff Ave Clewiston FL 33440-3818 Ph: (863) 983-5453 | Revamed Clewiston 406 S Deane Duff Ave Clewiston FL 33440-3818 Ph: (863) 983-5453 |
| NPI Number | 1811789696 |
|---|---|
| Provider Enumeration Date | 05/19/2025 |
| Last Update Date | 05/19/2025 |
| Certification Date | 05/19/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811789696 | NPI | - | NPPES |
| 1598062630 | Other | NPI | |
| 013400900 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | () | Secondary |
| 261QR1300X | Clinic/center - Rural Health | () | Primary |
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