MEDICARE: ROYAL LAB SERVICESLLC

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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1841941515
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROYAL LAB SERVICESLLC

Provider Business Mailing Address
First Line	:	11138 OLD SAINT CHARLES RD
Second Line	:
City	:	SAINT ANN
State	:	MO
Zip	:	63074-2113
Country	:	US
Telephone Number	:	314-755-1065
Fax Number	:	314-755-1028

Provider Business Practice Location Address
First Line	:	11138 OLD SAINT CHARLES RD
Second Line	:
City	:	SAINT ANN
State	:	MO
Zip	:	63074-2113
Country	:	US
Telephone Number	:	314-755-1065
Fax Number	:	314-755-1028

Authorized Official
Title or Position	:	OWNER
Name	:	CHARLNISHIA WILKINS
Credential	:
Telephone Number	:	314-755-1065

Provider Enumeration Date	:	01/14/2022
Last Update Date	:	05/13/2024

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Directions to “ROYAL LAB SERVICESLLC ” Practice Location

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