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REVITALIFE WELLNESS CENTER LLC
NPI 1104185685
Family Medicine in Saint Louis, MO

Active since May 03, 2012CLIA 26D2043709 · Waiver
777 S NEW BALLAS RD, STE 100E, SAINT LOUIS, MO 63141(314) 913-5861 Get Directions Write a Review

NPPES record last updated: May 23, 2012. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Revitalife Wellness Center Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

REVITALIFE WELLNESS CENTER LLC (NPI 1104185685) is a healthcare organization registered as a family medicine in Saint Louis, Missouri and active in the NPI registry since May 2012. The organization holds a CLIA Waiver certificate valid through July 8, 2028 and lists Christina Robins, President, as its authorized official.

NPPES Registry Identity

NPI1104185685
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameREVITALIFE WELLNESS CENTER LLC
Location Address777 S NEW BALLAS RD, STE 100ESaint Louis, MO 63141-8705
Mailing Address11402 Oxbridge CtSaint Louis, MO 63146-5491 · (314) 913-5861
Phone(314) 913-5861
Organization SubpartNo
Authorized OfficialChristina RobinsPresident · (314) 913-5861
Enumeration DateMay 3, 2012
Last NPPES UpdateMay 23, 2012
✔ NPI 1104185685 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
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.
777 S NEW BALLAS RD, Saint Louis, MO 63141
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 26D2043709

Revitalife Wellness Center, LLC · St. Louis, MO
Active · expires Jul 8, 2028
CLIA Number26D2043709
Laboratory TypePhysician Office
Certificate Effective DateJuly 9, 2026
Certificate Expiration DateJuly 8, 2028
Laboratory DirectorChristina A. Sowers
Laboratory Phone(314) 475-3126
Laboratory LocationRevitalife Wellness Center, LLC13354 Manchester Road, Suite 100, St. Louis, MO 63131
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DEBORAH MOLLY LEVIN LCSW, ACSW
Social Worker (Clinical)
777 S NEW BALLAS RD, SUITE 327W
SAINT LOUIS, MO 63141
St. Louis County (314) 997-4290
ST. LOUIS CENTER FOR PREVENTIVE AND LONGEVITY MEDICINE, LLC
Internal Medicine
777 S NEW BALLAS RD, SUITE 200 E
SAINT LOUIS, MO 63141
St. Louis County (314) 994-1536
DR. DAVID LAWRENCE LEE D.C.
Chiropractor
777 S NEW BALLAS RD, SUITE 212W
SAINT LOUIS, MO 63141
St. Louis County (314) 997-0069
DR. JOHN GRAHAM STEUTERMAN JR.
Dentist (General Practice)
777 S NEW BALLAS RD, SUITE 310-WEST
SAINT LOUIS, MO 63141
St. Louis County (314) 569-3660
ST. LOUIS CENTER FOR PREVENTATIVE AND LONGEVITY MEDICINE
Non-Pharmacy Dispensing Site
777 S NEW BALLAS RD, SUITE 200E
SAINT LOUIS, MO 63141
St. Louis County (413) 994-1536
DR. KURT HENRY STUDT DDS
Dentist
777 S NEW BALLAS RD, SUITE 225W
ST LOUIS, MO 63141
St. Louis County (314) 567-5556
PRABHA PARTAP MD
Clinical Medical Laboratory
777 S NEW BALLAS RD, SUITE 301E
SAINT LOUIS, MO 63141
St. Louis County (314) 692-0117
STEPHEN R CRESPIN INC
Internal Medicine (Endocrinology, Diabetes & Metabolism)
777 S NEW BALLAS RD, SUITE 214 EAST
SAINT LOUIS, MO 63141
St. Louis County (314) 432-1128

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Revitalife Wellness Center LLC's NPI number?

The NPI number for Revitalife Wellness Center LLC is 1104185685. It was assigned to this organization in the NPPES registry on May 3, 2012.

Where is Revitalife Wellness Center LLC located?

Revitalife Wellness Center LLC is located at 777 S New Ballas Rd Ste 100E, Saint Louis, MO 63141. The listed phone number is (314) 913-5861.

What is Revitalife Wellness Center LLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Revitalife Wellness Center LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 26D2043709) is associated with this NPI, valid through July 8, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Revitalife Wellness Center LLC was last updated on May 23, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.