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REVIVED VITALITY
NPI 1992588750
Clinic/Center in Myrtle Beach, SC

Active since August 16, 2023
1301 48TH AVE N # A-2, MYRTLE BEACH, SC 29577(843) 580-3694 Get Directions Write a Review

NPPES record last updated: August 16, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Revived Vitality NPPES

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

REVIVED VITALITY (NPI 1992588750) is a healthcare organization registered as a clinic/center in Myrtle Beach, South Carolina and active in the NPI registry since August 2023. The organization maintains a secondary practice location in Marco Island and lists Jennings Michael Perry, Owner/provider, as its authorized official.

NPPES Registry Identity

NPI1992588750
Entity TypeOrganization
Primary Taxonomy261Q00000X
Legal Business NameREVIVED VITALITY
Location Address1301 48TH AVE N # A-2Myrtle Beach, SC 29577-5427
Mailing Address606 Bald Eagle Dr Ste 201Marco Island, FL 34145-2731 · (843) 855-2299 · Fax (843) 353-2564
Phone(843) 580-3694
Organization SubpartNo
Authorized OfficialJennings Michael PerryOwner/provider · (843) 855-2299
Enumeration DateAugust 16, 2023
NPPES CertifiedAugust 16, 2023
✔ NPI 1992588750 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).
1301 48TH AVE N # A-2, Myrtle Beach, SC 29577
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Secondary Practice Location 1

Location 1606 Bald Eagle Dr Ste 201Marco Island, FL 34145-2731 · Phone (843) 855-2299 · Fax (843) 353-2564

Other Providers at the Same Location NPPES

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

JENNINGS MICHAEL PERRY DNP
Nurse Practitioner (Primary Care)
1301 48TH AVE N # A-2
MYRTLE BEACH, SC 29577
Horry County (843) 855-2299

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 Revived Vitality's NPI number?

The NPI number for Revived Vitality is 1992588750. It was assigned to this organization in the NPPES registry on August 16, 2023.

Where is Revived Vitality located?

Revived Vitality is located at 1301 48th Ave N # A-2, Myrtle Beach, SC 29577. The listed phone number is (843) 580-3694.

What is Revived Vitality'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 Revived Vitality was last updated on August 16, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.