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REVIVE FAMILY MEDICAL CLINIC, LLC
NPI 1902577554
Clinic/Center in Columbus, MS

Active since September 23, 2021
3549 BLUECUTT RD, COLUMBUS, MS 39705(662) 386-1541 Get Directions Write a Review

NPPES record last updated: November 18, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Nov 18, 2021, Sep 23, 2021 (2 updates tracked since 2021).

About Revive Family Medical Clinic, Llc NPPES

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

REVIVE FAMILY MEDICAL CLINIC, LLC (NPI 1902577554) is a healthcare organization registered as a clinic/center in Columbus, Mississippi and active in the NPI registry since September 2021. The organization lists Micah Alexander Grant, Nurse Practitioner, as its authorized official.

NPPES Registry Identity

NPI1902577554
Entity TypeOrganization
Primary Taxonomy261Q00000X
Legal Business NameREVIVE FAMILY MEDICAL CLINIC, LLC
Location Address3549 BLUECUTT RDColumbus, MS 39705-1324
Mailing Address3549 Bluecutt RdColumbus, MS 39705-1324 · (662) 570-4174 · Fax (662) 570-4108
Phone(662) 386-1541
Organization SubpartNo
Authorized OfficialMicah Alexander GrantNurse Practitioner · (662) 570-4174
Enumeration DateSeptember 23, 2021
Last NPPES UpdateNovember 18, 20212 updates tracked since enumeration
NPPES CertifiedNovember 18, 2021
✔ NPI 1902577554 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/CenterAmbulatory Health Care Facilities
Taxonomy Code261Q00000X
Definition
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
3549 BLUECUTT RD, Columbus, MS 39705
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Other Identifiers 4

OtherF0115273Aanp
Medicaid06975501MS
Other1437558061Npi-1
OtherR874310MS · Mississippi Board Of Nursing- Rn

Other Providers at the Same Location NPPES 3

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

MR. JAMES HARVEY GARRETT JR. MSPT
Physical Therapist
3549 BLUECUTT RD
COLUMBUS, MS 39705
Lowndes County (662) 295-1847
MICAH ALEXANDER GRANT FNP-C
Nurse Practitioner (Family)
3549 BLUECUTT RD
COLUMBUS, MS 39705
Lowndes County (662) 570-4174
REVIVE PHYSICAL THERAPY, LLC
Clinic/Center (Physical Therapy)
3549 BLUECUTT RD
COLUMBUS, MS 39705
Lowndes County (662) 295-1847

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 Revive Family Medical Clinic, LLC's NPI number?

The NPI number for Revive Family Medical Clinic, LLC is 1902577554. It was assigned to this organization in the NPPES registry on September 23, 2021.

Where is Revive Family Medical Clinic, LLC located?

Revive Family Medical Clinic, LLC is located at 3549 Bluecutt Rd, Columbus, MS 39705. The listed phone number is (662) 386-1541.

What is Revive Family Medical Clinic, LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.

When was this NPI record last updated?

The NPPES record for Revive Family Medical Clinic, LLC was last updated on November 18, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.