Provider Demographics
NPI:1013760586
Name:REVIVAL HYPERBARICS LLC
Entity Type:Organization
Organization Name:REVIVAL HYPERBARICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WREN
Authorized Official - Middle Name:EVAN
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-251-7799
Mailing Address - Street 1:11649 S 4000 W STE 110
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-6039
Mailing Address - Country:US
Mailing Address - Phone:208-251-7799
Mailing Address - Fax:
Practice Address - Street 1:11649 S 4000 W STE 110
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84009-6039
Practice Address - Country:US
Practice Address - Phone:208-251-7799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Single Specialty