| Revenge Medical Inc | |
|
343 Elm St Ste 201 Reno NV 89503-4538 | |
| (775) 470-6651 | |
| (775) 622-0788 |
| Full Name | Revenge Medical Inc |
|---|---|
| Speciality | Specialist |
| Location | 343 Elm St Ste 201, Reno, Nevada |
| Authorized Official Name and Position | Edin Abdagic (MEDICAL DIRECTOR / OWNER) |
| Authorized Official Contact | 7026901633 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revenge Medical Inc 343 Elm St Ste 201 Reno NV 89503-4538 Ph: (775) 470-6651 | Revenge Medical Inc 343 Elm St Ste 201 Reno NV 89503-4538 Ph: (775) 470-6651 |
| NPI Number | 1942921200 |
|---|---|
| Provider Enumeration Date | 09/06/2022 |
| Last Update Date | 02/16/2023 |
| Medicare PECOS PAC ID | 1052788254 |
|---|---|
| Medicare Enrollment ID | O20221101000653 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942921200 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Secondary |
| 174400000X | Specialist | (* (Not Available)) | Primary |
| Provider Name | Edin Abdagic |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679900195 PECOS PAC ID: 5991072522 Enrollment ID: I20201221002592 |
| Provider Name | Kayla Marie Hopkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598460032 PECOS PAC ID: 9133584139 Enrollment ID: I20230426002210 |
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