| Revive Medical Usa Inc | |
|
2926 Mountain Industrial Blvd Tucker GA 30084-3012 | |
| (678) 379-1731 | |
| (678) 248-2377 |
| Full Name | Revive Medical Usa Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2926 Mountain Industrial Blvd, Tucker, Georgia |
| Authorized Official Name and Position | Gurleen Kaur (PRESIDENT) |
| Authorized Official Contact | 7088608111 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revive Medical Usa Inc 4474 Valtek Ct Suwanee GA 30024-6209 Ph: (708) 300-5950 | Revive Medical Usa Inc 2926 Mountain Industrial Blvd Tucker GA 30084-3012 Ph: (678) 379-1731 |
| NPI Number | 1245950930 |
|---|---|
| Provider Enumeration Date | 09/01/2022 |
| Last Update Date | 05/25/2023 |
| Medicare PECOS PAC ID | 6507238375 |
|---|---|
| Medicare Enrollment ID | O20230206000850 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245950930 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Sonu Gupta |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1568727220 PECOS PAC ID: 5799093621 Enrollment ID: I20180709000482 |
| Provider Name | Gurleen Kaur |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1447529441 PECOS PAC ID: 0244458909 Enrollment ID: I20200122002986 |
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