Reviv PLLC
NPI 1114595824ActiveOrganization· General Practice· Fargo, ND
General Practice in Fargo, North Dakota, registered in NPPES in June 2021. The authorized official on file is Laura Lisa Job, Operations Manager.
Overview
| NPI | 1114595824 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Jun 17, 2021 |
| Last updated in NPPES | Feb 4, 2025 |
| Certified by provider | Feb 4, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| General Practice Primary | 208D00000X | — | — |
| Clinic/Center, Health Services | 261QH0100X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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