Healthcare Provider Details

I. General information

NPI: 1609316389
Provider Name (Legal Business Name): ROYALTY INTERVENTION GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2017
Last Update Date: 02/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 W 95TH ST 1 EAST
CHICAGO IL
60643-1001
US

IV. Provider business mailing address

2215 W 95TH ST 1 EAST
CHICAGO IL
60643-1001
US

V. Phone/Fax

Practice location:
  • Phone: 773-779-8260
  • Fax: 773-779-8261
Mailing address:
  • Phone: 773-239-9600
  • Fax: 773-239-9601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. ANGELA J RATCLIFFE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 773-779-8260