Provider Demographics
NPI:1215389655
Name:REVOLUTION MONITORING MANAGEMENT, LLC
Entity type:Organization
Organization Name:REVOLUTION MONITORING MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMIAH
Authorized Official - Middle Name:TITUS
Authorized Official - Last Name:VANCE
Authorized Official - Suffix:
Authorized Official - Credentials:CNIM
Authorized Official - Phone:214-228-1257
Mailing Address - Street 1:4925 GREENVILLE AVE #200
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206
Mailing Address - Country:US
Mailing Address - Phone:844-663-2229
Mailing Address - Fax:469-385-8892
Practice Address - Street 1:4925 GREENVILLE AVE #200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206
Practice Address - Country:US
Practice Address - Phone:844-663-2229
Practice Address - Fax:469-385-8892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty