=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427144682
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROYAL MEDICAL SUPPLIES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2006
-----------------------------------------------------
Last Update Date | 08/18/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 W RANDOL MILL RD STE 209
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76011-4611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-548-0550
-----------------------------------------------------
Fax | 817-548-0540
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 W RANDOL MILL RD STE 209
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76011-4611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-548-0550
-----------------------------------------------------
Fax | 817-548-0540
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. ADEWALE AKANNI SHODEKE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 817-548-0550
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 0075595
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------