1. Home
  2. Directory
  3. North Dakota
  4. Fargo
  5. General Practice
  6. NPI Profile

REVIV PLLC
NPI 1114595824
General Practice in Fargo, ND

Active since June 17, 2021
3029 BRANDT DR S STE A, FARGO, ND 58104(701) 566-5306 Get Directions Write a Review

NPPES record last updated: February 4, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Feb 4, 2025, Jun 21, 2021, Jun 17, 2021 (3 updates tracked since 2021).

About Reviv Pllc NPPES

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

REVIV PLLC (NPI 1114595824) is a healthcare organization registered as a general practice in Fargo, North Dakota and active in the NPI registry since June 2021. The organization lists Laura Lisa Job, Operations Manager, as its authorized official.

NPPES Registry Identity

NPI1114595824
Entity TypeOrganization
Primary Taxonomy208D00000X
Legal Business NameREVIV PLLC
Location Address3029 BRANDT DR S STE AFargo, ND 58104-9140
Mailing Address3029 Brandt Dr S Ste AFargo, ND 58104-9140 · (701) 566-5306
Phone(701) 566-5306
Organization SubpartNo
Authorized OfficialLaura Lisa JobOperations Manager · (701) 526-6530
Enumeration DateJune 17, 2021
Last NPPES UpdateFebruary 4, 20253 updates tracked since enumeration
NPPES CertifiedFebruary 4, 2025
✔ NPI 1114595824 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
Definition
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee
Also ListedClinic/Center · Health ServiceTaxonomy 261QH0100X
3029 BRANDT DR S STE A, Fargo, ND 58104
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross Blue Shield of North Dakota, Sanford Health Plan.Insurance ›

Other Providers at the Same Location NPPES 2

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

ERIN ELIZA LUBITZ BS, RN, DNP-C
Nurse Practitioner (Primary Care)
3029 BRANDT DR S STE A
FARGO, ND 58104
Cass County (701) 566-5306
CLARITY BRAIN CENTER LLC
Chiropractor
3029 BRANDT DR S STE A
FARGO, ND 58104
Cass County (701) 566-5306

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 Reviv PLLC's NPI number?

The NPI number for Reviv PLLC is 1114595824. It was assigned to this organization in the NPPES registry on June 17, 2021.

Where is Reviv PLLC located?

Reviv PLLC is located at 3029 Brandt Dr S Ste A, Fargo, ND 58104. The listed phone number is (701) 566-5306.

What is Reviv PLLC's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

What insurance does Reviv PLLC accept?

Health plans from Blue Cross Blue Shield of North Dakota and Sanford Health Plan list Reviv PLLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Reviv PLLC was last updated on February 4, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 months 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.