| Revitalize Alabama L.l.c | |
|
105 1st Street Auburn AL 36830-0000 | |
| (334) 734-7973 | |
| Not Available |
| Full Name | Revitalize Alabama L.l.c |
|---|---|
| Speciality | Family Medicine |
| Location | 105 1st Street, Auburn, Alabama |
| Authorized Official Name and Position | Travis Woodley (PRESIDENT) |
| Authorized Official Contact | 3347347973 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revitalize Alabama L.l.c Po Box 2738 Opelika AL 36803-2738 Ph: (334) 734-7973 | Revitalize Alabama L.l.c 105 1st Street Auburn AL 36830-0000 Ph: (334) 734-7973 |
| NPI Number | 1942975180 |
|---|---|
| Provider Enumeration Date | 08/10/2021 |
| Last Update Date | 10/06/2021 |
| Medicare PECOS PAC ID | 4082012836 |
|---|---|
| Medicare Enrollment ID | O20211007002599 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942975180 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Travis Woodley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396274072 PECOS PAC ID: 7810262045 Enrollment ID: I20171013001138 |
| Provider Name | Amy Askew Sanderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790108736 PECOS PAC ID: 3870716459 Enrollment ID: I20200723000040 |
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