MEDICARE: MR. MARCEL MARC ROYAL EMT - INTERMEDIATE

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	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1720358229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARCEL MARC ROYAL EMT - INTERMEDIATE

Provider Business Mailing Address
First Line	:	PO BOX 50771
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29485-0771
Country	:	US
Telephone Number	:	843-408-6408
Fax Number	:

Provider Business Practice Location Address
First Line	:	8465 PATRIOT BLVD
Second Line	:	APT. 1
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29420-7407
Country	:	US
Telephone Number	:	843-408-6408
Fax Number	:

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

Provider Enumeration Date	:	12/31/2011
Last Update Date	:	12/31/2011

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