=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326024936
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROYAL TREATMENT URGENT MEDICAL CARE CENTER INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/16/2005
-----------------------------------------------------
Last Update Date | 07/20/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1106 OHIO RIVER BLVD # 602
-----------------------------------------------------
City | SEWICKLEY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15143-2048
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-819-0488
-----------------------------------------------------
Fax | 412-202-5375
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4017 WASHINGTON RD # 2000
-----------------------------------------------------
City | MC MURRAY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15317-2520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-202-5375
-----------------------------------------------------
Fax | 412-202-5375
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. STACEY Y ROYAL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 419-819-0488
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 4301073222
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | 35079907R
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MD434643
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------