MEDICARE: ROYAL CARE MEDICAL CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	35026933	OH

General Provider Information

NPI Number	:	1528360922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROYAL CARE MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	850 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44114-3306
Country	:	US
Telephone Number	:	216-482-1071
Fax Number	:

Provider Business Practice Location Address
First Line	:	850 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44114-3306
Country	:	US
Telephone Number	:	216-482-1071
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	CHARLES ADAMS
Credential	:
Telephone Number	:	216-482-1071

Provider Enumeration Date	:	11/17/2010
Last Update Date	:	11/17/2010

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