Provider Demographics
NPI:1629399977
Name:REVOLUTION HEALTH CENTER PLC
Entity Type:Organization
Organization Name:REVOLUTION HEALTH CENTER PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:MONROE
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-566-7628
Mailing Address - Street 1:3048 ALBERENE CHURCH LN
Mailing Address - Street 2:
Mailing Address - City:ESMONT
Mailing Address - State:VA
Mailing Address - Zip Code:22937-1516
Mailing Address - Country:US
Mailing Address - Phone:434-566-7628
Mailing Address - Fax:
Practice Address - Street 1:190 JAMES RIVER RD
Practice Address - Street 2:
Practice Address - City:SCOTTSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24590-3812
Practice Address - Country:US
Practice Address - Phone:434-321-5257
Practice Address - Fax:434-321-5259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101239018207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty