Provider Demographics
NPI:1255084950
Name:REVELATION MEDICAL OF BARTLESVILLE LLC
Entity type:Organization
Organization Name:REVELATION MEDICAL OF BARTLESVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:LINN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-876-4328
Mailing Address - Street 1:234 SE DE BELL AVE
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006
Mailing Address - Country:US
Mailing Address - Phone:918-876-4328
Mailing Address - Fax:
Practice Address - Street 1:234 SE DE BELL AVE
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006
Practice Address - Country:US
Practice Address - Phone:918-876-4328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty