MEDICARE: RICHARD APOLLO RN

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	163WA2000X	Administrator Registered Nurse	1-101055	AL

General Provider Information

NPI Number	:	1700126778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD APOLLO RN

Provider Business Mailing Address
First Line	:	1605 OAK PARK LN
Second Line	:
City	:	HELENA
State	:	AL
Zip	:	35080-7749
Country	:	US
Telephone Number	:	205-277-9790
Fax Number	:

Provider Business Practice Location Address
First Line	:	2090 COLUMBIANA RD
Second Line	:	STE 1100
City	:	VESTAVIA
State	:	AL
Zip	:	35216-2153
Country	:	US
Telephone Number	:	205-536-8487
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2013
Last Update Date	:	02/27/2013

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