Provider Demographics
NPI:1073898292
Name:ROYAL MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:ROYAL MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:REPKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-705-9292
Mailing Address - Street 1:2125 28TH ST SW
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-7380
Mailing Address - Country:US
Mailing Address - Phone:610-705-9292
Mailing Address - Fax:610-705-9777
Practice Address - Street 1:2125 28TH ST SW
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-7380
Practice Address - Country:US
Practice Address - Phone:610-782-9101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-19
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA3000007437332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019576510002Medicaid
4705820001Medicare NSC