Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.

Revival Health and Wellness Clinic

Organization Family Medicine Physician · NPI 1366241507

Revival Health and Wellness Clinic provides Family Medicine Physician services in Salem, Illinois. Registered with an NPI since 2025.

In the registry since
2025

Practice location Address checks out

207 E Main St
Salem, IL 62881-2926
Phone: (706) 889-8349
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X

Record details

NPI number1366241507
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Crea Rose — Owner/ Provider · (706) 889-8349
NPI enumeratedMarch 11, 2025
Last updated in NPPESJune 27, 2025
Certification dateJune 27, 2025
Mailing address1602 Woods Ln, Centralia, IL 62801-6774

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