Healthcare Provider Details

I. General information

NPI: 1851915052
Provider Name (Legal Business Name): ROYALL EM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2020
Last Update Date: 06/03/2020
Certification Date: 06/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N HOSPITAL DR
PRICE UT
84501-4218
US

IV. Provider business mailing address

6734 S 2680 E
SALT LAKE CITY UT
84121-3252
US

V. Phone/Fax

Practice location:
  • Phone: 801-597-5985
  • Fax:
Mailing address:
  • Phone: 801-597-5985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CAMERON ROYALL
Title or Position: OWNER
Credential: MD
Phone: 801-597-5985