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Revive Medical LLC — NPI 1669087045, Bolivar, MO | NPI Central

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NPI 1669087045

OrganizationActive

Revive Medical LLC

NPI 1669087045 · Medical Foods Supplier · Bolivar, MO

Provider details

NPI number: 1669087045
Entity type: Organization
Primary specialty: Medical Foods SupplierSuppliers
Organization subpart: No
Authorized official: Troy Morrison, Owner(417) 777-0797

Specialties & taxonomies

Medical Foods SupplierPrimary335G00000X
Suppliers
Parenteral & Enteral Nutrition Supplies (DME)332BP3500X
Suppliers

Practice location

5000

S Scenic

Bolivar, MO 65613

Phone: (417) 777-0797

Approximate (ZIP-level) locationGet directions

More MO providers

Mailing address

5000

Bolivar, MO 65613

Other names (DBA / former)

Other name: Ricochet Nutrition

Registry dates

Enumerated: 2020-09-11
Last updated: 2020-09-11
Certified: 2020-09-11

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.