Provider Demographics
NPI:1043780067
Name:REVAMED HEALTHCARE PARTNERS LLC
Entity Type:Organization
Organization Name:REVAMED HEALTHCARE PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OPERATIONS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:STIELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-432-2164
Mailing Address - Street 1:8132 OKEECHOBEE BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-2000
Mailing Address - Country:US
Mailing Address - Phone:561-290-1181
Mailing Address - Fax:
Practice Address - Street 1:3084 S JOG RD
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33467-2053
Practice Address - Country:US
Practice Address - Phone:561-708-1760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-03
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty