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Contact Information

REVAN LLC
3890 TAMPA RD STE 201
PALM HARBOR, FL34684-3677
 Phone: 727-781-3111
 Fax: 727-781-3113
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Undersea and Hyperbaric Medicine

207PE0005X 93 Physician/Emergency Medicine
Indicates primary specialty

NPI Profile & details for REVAN LLC

NPI # 1730145673
LBN Legal business name REVAN LLC
Authorized official CHARLES BOOTHBY - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 04/20/2006
Last updated 07/01/2015 - About 11 years ago
Identifiers
FL License # OS4598
FL Medicaid 069165800
FL Other 82569 BCBS FL
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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