Provider Demographics
NPI:1326024936
Name:ROYAL TREATMENT URGENT MEDICAL CARE CENTER INC.
Entity Type:Organization
Organization Name:ROYAL TREATMENT URGENT MEDICAL CARE CENTER INC.
Other - Org Name:STACEY ROYAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:Y
Authorized Official - Last Name:ROYAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-819-0488
Mailing Address - Street 1:4017 WASHINGTON RD
Mailing Address - Street 2:# 2000
Mailing Address - City:MC MURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-2520
Mailing Address - Country:US
Mailing Address - Phone:412-202-5375
Mailing Address - Fax:412-202-5375
Practice Address - Street 1:1106 OHIO RIVER BLVD
Practice Address - Street 2:# 602
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-2048
Practice Address - Country:US
Practice Address - Phone:419-819-0488
Practice Address - Fax:412-202-5375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-16
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD434643207Q00000X
MI4301073222261Q00000X
OH35079907R261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1022563590001Medicaid
OH2268139Medicaid
PA1022588090001Medicaid
OH2750876Medicaid
OH9364911Medicare PIN
OHH47499Medicare UPIN
PA1022588090001Medicaid
PA1022563590001Medicaid
PA147754ZC5FMedicare PIN
OH4059457Medicare PIN