Provider Demographics
NPI:1881359180
Name:REVOLUTION HEALTH PC
Entity type:Organization
Organization Name:REVOLUTION HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:KLINGLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-716-1890
Mailing Address - Street 1:121 E FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:COLON
Mailing Address - State:MI
Mailing Address - Zip Code:49040-9363
Mailing Address - Country:US
Mailing Address - Phone:269-319-8850
Mailing Address - Fax:269-464-0101
Practice Address - Street 1:121 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:COLON
Practice Address - State:MI
Practice Address - Zip Code:49040-9363
Practice Address - Country:US
Practice Address - Phone:269-319-8850
Practice Address - Fax:269-464-0101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care