Agency Information

REVOS HEALTH LLC

5 COWBOYS WAY STE 300G

FRISCO, TX 75034

214-717-7505

contracting@revolthealthcare.com

19765342

License Type	License Number	Original Issue Date	Status	Effective Date	Expiration Date
Non-Res. Producer Firm	3698019	07/22/2021	Active	07/22/2021	07/31/2027

Qualification Type	Original Issue Date	Status	Effective Date
Health	07/22/2021	Active	07/22/2021
Life	07/22/2021	Active	07/22/2021

Company Name	Appointment Type	Status	Active Date
523
PHILADELPHIA AMERICAN LIFE INSURANCE COMPANY	Health	Active	09/29/2021
	Life	Active	09/29/2021

row(s) 1 - 2 of 2

Name	Association Type	Agent	Begin Date	End Date
BENTON MICHAEL JONES	Designated Resp Lic Prdcr	No	07/22/2021	-

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