| Revived Wellness LLC | |
|
776 E 800 S Centerville UT 84014-2512 | |
| (801) 424-9922 | |
| Not Available |
| Full Name | Revived Wellness LLC |
|---|---|
| Speciality | Family Medicine |
| Location | 776 E 800 S, Centerville, Utah |
| Authorized Official Name and Position | Jonathan Barker (MANAGER) |
| Authorized Official Contact | 8014992373 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revived Wellness LLC 776 E 800 S Centerville UT 84014-2512 Ph: (801) 424-9922 | Revived Wellness LLC 776 E 800 S Centerville UT 84014-2512 Ph: (801) 424-9922 |
| NPI Number | 1891653523 |
|---|---|
| Provider Enumeration Date | 01/12/2026 |
| Last Update Date | 01/12/2026 |
| Certification Date | 01/12/2026 |
| Medicare PECOS PAC ID | 0749763589 |
|---|---|
| Medicare Enrollment ID | O20260311002128 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891653523 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| Provider Name | Gon Thi Lam |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891179339 PECOS PAC ID: 6002126844 Enrollment ID: I20151109000117 |
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