Provider Demographics
NPI:1417665811
Name:ROYAL MEDRIDE LLC
Entity Type:Organization
Organization Name:ROYAL MEDRIDE LLC
Other - Org Name:ROYAL MED HEALTHCARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AKEEM
Authorized Official - Middle Name:OLATUNJI
Authorized Official - Last Name:ODUTAYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-815-9920
Mailing Address - Street 1:16634 E 41ST PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74134-5990
Mailing Address - Country:US
Mailing Address - Phone:918-815-9920
Mailing Address - Fax:
Practice Address - Street 1:16634 E 41ST PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74134-5990
Practice Address - Country:US
Practice Address - Phone:918-815-9920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-14
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No251E00000XAgenciesHome Health