Provider Demographics
NPI:1326118894
Name:ROYAL LIMO SERVICE
Entity Type:Organization
Organization Name:ROYAL LIMO SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:260-458-9530
Mailing Address - Street 1:4925 AVONDALE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46806-3104
Mailing Address - Country:US
Mailing Address - Phone:260-458-9530
Mailing Address - Fax:260-458-9530
Practice Address - Street 1:4925 AVONDALE DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46806-3104
Practice Address - Country:US
Practice Address - Phone:260-458-9530
Practice Address - Fax:260-458-9530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN46400343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200405770AMedicaid