=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881306371
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROYAL QUAIL BUSINESS SOLUTIONS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/16/2022
-----------------------------------------------------
Last Update Date | 12/16/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2744 US HIGHWAY 1 S
-----------------------------------------------------
City | ST AUGUSTINE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32086-6366
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-217-0479
-----------------------------------------------------
Fax | 904-600-4583
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2744 US HIGHWAY 1 S
-----------------------------------------------------
City | ST AUGUSTINE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32086-6366
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-217-0479
-----------------------------------------------------
Fax | 904-600-4583
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER / LABORATORY DIRECTOR
-----------------------------------------------------
Name | MR. AKINKAWON FRIERSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 904-217-0479
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------