REVIVE KETAMINE CLINIC, PLLC
NPI 1053984484
Clinic/Center - Medical Specialty in Bartlett, TN
NPI Status: Active since July 22, 2021
Contact Information
5820 STAGE RD
BARTLETT, TN
ZIP 38134
Phone: (901) 317-7900
Fax: (901) 317-7899
- Organization
- Clinic/Center
- Medical Specialty
- CLIA Number: 44D2186319
- CLIA Cert. Type: Other - INFUSION CLINIC
- CLIA Exp. Date: 06-15-2026
About REVIVE KETAMINE CLINIC, PLLC
This page provides the complete NPI Profile along with additional information for Revive Ketamine Clinic, Pllc, a provider established in Bartlett, Tennessee operating as a Clinic/center, focusing in medical specialty . The healthcare provider is registered in the NPI registry with number 1053984484 assigned on July 2021. The practitioner's primary taxonomy code is 261QM2500X. The provider is registered as an organization and their NPI record was last updated 2 years ago. The authorized official of this NPI record is Dr. Ginger Williams Dnp, Crna (Owner/practitioner)
- NPI
- 1053984484
- Provider Name
- REVIVE KETAMINE CLINIC, PLLC
- Entity Type
- Organization
- Location Address
- 5820 STAGE RD BARTLETT, TN 38134
- Location Phone
- (901) 317-7900
- Location Fax
- (901) 317-7899
- Mailing Address
- 5820 STAGE RD BARTLETT, TN 38134
- Mailing Phone
- (901) 317-7900
- Mailing Fax
- (901) 317-7899
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 07-22-2021
- Last Update Date
- 04-15-2024
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center Medical Specialty
- Taxonomy Code
- 261QM2500X
- Type
- Ambulatory Health Care Facilities
- Taxonomy Description
- An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 44D2186319
- Facility Type
- Other - INFUSION CLINIC
- Certificate Effective Date
- June 16, 2024
- Certificate Expiration Date
- June 15, 2026
- Laboratory Director
- GINGER M. WILLIAMS
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Revive Ketamine Clinic, Pllc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
Reviews for REVIVE KETAMINE CLINIC, PLLC
There are currently no reviews for this provider. Be the first person to share your experience with this provider by filling out our review form. Your insights are appreciated and will help others make informed decisions.
NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1053984484, we treat the final digit (4) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 66. The final step is to find the difference between that total and the next multiple of ten (70 - 66 = 4).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 66 is 70. The difference is the calculated check digit.
Other Providers at the Same Location
The following 2 providers are registered at the same or a nearby location.
BARTLETT, TN 38134
BARTLETT, TN 38134
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1053984484, enumerated as an "organization" on July 22, 2021.
The provider is located at 5820 STAGE RD BARTLETT, TN 38134 and the phone number is (901) 317-7900.
Clinic/Center with taxonomy code 261QM2500X and a focus in Medical Specialty.
