| Revive Pain Centers PA | |
|
14525 Highway 7 Ste 375 Minnetonka MN 55345-3741 | |
| (651) 308-6190 | |
| Not Available |
| Full Name | Revive Pain Centers PA |
|---|---|
| Speciality | Family Medicine |
| Location | 14525 Highway 7 Ste 375, Minnetonka, Minnesota |
| Authorized Official Name and Position | Troy Stuckey (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 6513086190 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Revive Pain Centers PA 14525 Highway 7 Ste 375 Minnetonka MN 55345-3741 Ph: (651) 308-6190 | Revive Pain Centers PA 14525 Highway 7 Ste 375 Minnetonka MN 55345-3741 Ph: (651) 308-6190 |
| NPI Number | 1760005771 |
|---|---|
| Provider Enumeration Date | 05/26/2020 |
| Last Update Date | 05/26/2020 |
| Certification Date | 05/26/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760005771 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (NU) | Primary |
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