My Medical Massage

LBN: I-Revive Pllc
My Medical Massage is an health care organization with primary practice located at 525 Elliott Ave , Grand Haven MI 49417-1038. The organization recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Preventive Medicine/Occupational Environmental Medicine, Agencies / Home Health. Allopathic & Osteopathic Physicians / Preventive Medicine/Occupational Environmental Medicine is the primary health care specialty. I-Revive Pllc can be contacted via phone (616) 566-1603, or through Converse, Amanda M via phone (616) 377-8893.

Contact Information

Primary practice address
525 Elliott Ave Grand Haven MI 49417-1038
Phone: (616) 566-1603
Fax: (616) 607-8588
Website:
Map and Directions
Authorized official contact:
Name: Converse, Amanda M LMT, CIMT, CPMT
Phone: (616) 377-8893

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Preventive Medicine/Occupational Environmental Medicine 2083P0500X
Agencies / Home Health 251E00000X

Profile Details

NPI number 1508473000
LBN Legal business name I-Revive Pllc
DBA Doing business as My Medical Massage
Authorized official Converse, Amanda M LMT, CIMT, CPMT
Entity Organization
Organization subpart 1 No
Enumeration date Sep 28th, 2020
Last updated Nov 5th, 2020 - about 4 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1508473000 NPPES
Michigan Other 14997664 CAQH

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