REVITALIFE WELLNESS CENTER LLC (NPI# 1104185685) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104185685 |
| Entity Type | Organization |
| Organization Name | REVITALIFE WELLNESS CENTER LLC |
| Practice Address |
777 S New Ballas Rd Ste 100e Saint Louis MO 63141-8705 |
| Mailing Address |
11402 Oxbridge Ct Saint Louis MO 63146-5491 |
| Practice Telephone | 3149135861 |
| Mailing Telephone | 3149135861 |
| Enumeration Date | 2012-05-03 |
| Last Update Date | 2012-05-23 |
| Authorized Official Name | DR. CHRISTINA ROBINS (PRESIDENT) |
| Authorized Official Telephone | 3149135861 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Street Address |
777 S NEW BALLAS RD STE 100E |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63141-8705 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265436711 | Robert Daniel Craig | Otolaryngology | 777 S New Ballas Rd, Ste 320e, Saint Louis, MO 63141-8789 | 2005-06-10 |
| 1124597844 | Hailey B Cronin | Pharmacist | 777 S New Ballas Rd, Saint Louis, MO 63141-8705 | 2018-11-26 |
| 1326588856 | Options In Pyhsical Therapy | Clinic/Center | 777 S New Ballas Rd, Suite 218e, Saint Louis, MO 63141-8705 | 2017-03-02 |
| 1730638958 | West County Pharmacy LLC | Pharmacy | 777 S New Ballas Rd, Saint Louis, MO 63141-8705 | 2016-09-29 |
| 1205290749 | Advanced Family Medicine, LLC | Nurse Practitioner | 777 S New Ballas Rd, Ste 100e, Saint Louis, MO 63141-8705 | 2016-04-11 |
| 1174984918 | Jessica Loverude | Speech-Language Pathologist | 777 S New Ballas Rd, Suite 328w, Saint Louis, MO 63141-8705 | 2016-03-07 |
| 1548637853 | Chilcutt & Steuterman, Dds, LLC | Clinic/Center | 777 S New Ballas Rd, Ste. 310 West, Saint Louis, MO 63141-8705 | 2015-08-24 |
| 1922425784 | Savita S Bhat Md LLC | Psychologist | 777 S New Ballas Rd, Suite 217e, Saint Louis, MO 63141-8705 | 2014-03-18 |
| 1467874982 | N & W Associates Inc | Physical Medicine & Rehabilitation | 777 S New Ballas Rd, Suite 302w, Saint Louis, MO 63141-8705 | 2014-01-17 |
| 1962767665 | Charles William Pelton | Optometrist | 777 S New Ballas Rd, Suite 218e, Saint Louis, MO 63141-8705 | 2012-07-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679102842 | Noor Ramadan | Pharmacist | 628 North New Ballad Road, Suite A, Creve Coeur, MO 63141 | 2020-04-08 |
| 1497381206 | Washington University | Durable Medical Equipment & Medical Supplies | 1044 North Mason Road, Suite 110/210, St. Louis, MO 63141 | 2020-03-13 |
| 1154956498 | Ashleigh Clendenny | Physician Assistant | Mercy Hospital St. Louis, 615 S New Ballas Rd, St. Louis, MO 63141 | 2020-03-06 |
| 1801429410 | Emili Lou Haley | Registered Nurse | 650 Maryville Drive, St Louis, MO 63141 | 2020-02-21 |
| 1629553110 | Rebecca Kathleen Pike | Social Worker | West County Psychological Associates, 12125 Woodcrest Executive Drive #110, St. Louis, MO 63141 | 2018-10-01 |
| 1649756099 | River City Sedation Associates, LLC | Nurse Anesthetist, Certified Registered | 12855 N 40 Dr Ste 150, Saint Louis, MO 63141 | 2018-07-18 |
| 1205333952 | Ear Care and Hearing of St. Louis | Hearing Aid Equipment | 11630 Studt Ave Ste 210, Creve Coeur, MO 63141 | 2018-04-10 |
| 1659897486 | Erin Goodman | Physical Therapist | 10560 Old Olive St. Rd, Suite 100, Creve Coeur, MO 63141 | 2017-08-14 |
| 1093230450 | Center for Urologic Surgery LLC | Clinic/Center | 12855 N 40 Dr Ste 100, Saint Louis, MO 63141 | 2017-08-07 |
| 1871016105 | Jacob Farley Tanner | Specialist/Technologist | 1054 Town and Four Parkway Dr, Creve Coeur, MO 63141 | 2017-07-19 |
| Find all providers in zip 63141 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356986541 | Pain Relief Center of St Louis LLC | Family Medicine | 1115 Olivette Executive Pkwy, Saint Louis, MO 63132-3259 | 2019-11-12 |
| 1720635329 | Mercy Clinic East Communities | Family Medicine | 10004 Kennerly Rd Ste 395b, Saint Louis, MO 63128-2190 | 2019-08-20 |
| 1063066777 | Isabella Citizens for Health, Inc. | Family Medicine | 312 Union St, Saint Louis, MI 48880-1830 | 2019-07-31 |
| 1043864010 | Isabella Citizens for Health, Inc. | Family Medicine | 113 E Saginaw St, Saint Louis, MI 48880-1755 | 2019-07-29 |
| 1558896969 | Shivani Sockanathan | Family Medicine | 969 N Mason Rd Ste 145a, Saint Louis, MO 63141-6282 | 2017-04-23 |
| 1598299646 | Kharole Compere | Family Medicine | 175 N Oaks Plz, Saint Louis, MO 63121-2925 | 2017-04-16 |
| 1396109880 | Ritesh Gandhi | Family Medicine | 7345 Watson Rd Ste 203, Saint Louis, MO 63119 | 2016-04-11 |
| 1144608035 | Daniel Urcuyo | Family Medicine | 4625 Lindell Blvd Ste 338, Saint Louis, MO 63108 | 2015-05-11 |
| 1376958728 | Jamil Neme | Family Medicine | 3660 Vista Ave Ste 103, Saint Louis, MO 63110-2540 | 2014-06-24 |
| 1144633819 | Perini Shah | Family Medicine | 12700 Southfork Rd Ste 215, Saint Louis, MO 63128-3276 | 2014-06-10 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63141 |
Please comment or provide details below to improve the information on REVITALIFE WELLNESS CENTER LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.