Basic Information
| Provider Information | |||||||||
| NPI: | 1073898292 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROYAL MEDICAL SUPPLY INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2125 28TH ST SW | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181037380 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6107059292 | ||||||||
| FaxNumber: | 6107059777 | ||||||||
| Practice Location | |||||||||
| Address1: | 2125 28TH ST SW | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181037380 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6107829101 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2011 | ||||||||
| LastUpdateDate: | 07/12/2012 | ||||||||
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| AuthorizedOfficialLastName: | REPKO | ||||||||
| AuthorizedOfficialFirstName: | ROY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6107059292 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 3000007437 | PA | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 0019576510002 | 05 | PA | MEDICAID |