MEDICARE: ROYALTECH, LLC

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	335V00000X	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier

General Provider Information

NPI Number	:	1588105423
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROYALTECH, LLC

Provider Business Mailing Address
First Line	:	1703 E CACHE LA POUDRE ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-4613
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1703 E CACHE LA POUDRE ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-4613
Country	:	US
Telephone Number	:	719-646-8056
Fax Number	:

Authorized Official
Title or Position	:	RADIOLOGIC TECHNOLOGIST
Name	:	JONATHAN BRUCE
Credential	:
Telephone Number	:	719-646-8056

Provider Enumeration Date	:	03/11/2017
Last Update Date	:	03/11/2017

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