Provider Demographics
NPI:1679273254
Name:REVIVE CONTINUUM
Entity Type:Organization
Organization Name:REVIVE CONTINUUM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:SHAUBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:936-402-2935
Mailing Address - Street 1:15329 WOODSTONE CIR
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24202-4023
Mailing Address - Country:US
Mailing Address - Phone:276-245-6085
Mailing Address - Fax:
Practice Address - Street 1:157 LANCASTER ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-4169
Practice Address - Country:US
Practice Address - Phone:276-250-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty