Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Revival Health and Wellness Clinic

Organization Family Medicine Physician · NPI 1366241507

Revival Health and Wellness Clinic is a Family Medicine Physician 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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