MEDICARE: ORION ROYAL OAKS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	36D0338434	OH

General Provider Information

NPI Number	:	1346493418
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORION ROYAL OAKS LLC

Provider Business Mailing Address
First Line	:	6973 PEARL RD
Second Line	:
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-7831
Country	:	US
Telephone Number	:	440-884-9191
Fax Number	:

Provider Business Practice Location Address
First Line	:	6973 PEARL RD
Second Line	:
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-7831
Country	:	US
Telephone Number	:	440-884-9191
Fax Number	:

Authorized Official
Title or Position	:	CONTROLLER
Name	:	DENNIS LOCKHART
Credential	:
Telephone Number	:	614-416-0600

Provider Enumeration Date	:	11/03/2008
Last Update Date	:	11/03/2008

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