Provider Demographics
NPI:1639936289
Name:ROYALTY CONCIERGE & MEN'S HEALTH
Entity Type:Organization
Organization Name:ROYALTY CONCIERGE & MEN'S HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:804-924-7200
Mailing Address - Street 1:13702 VILLAGE MILL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-8801
Mailing Address - Country:US
Mailing Address - Phone:804-924-7200
Mailing Address - Fax:
Practice Address - Street 1:13702 VILLAGE MILL DR STE 200
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-8801
Practice Address - Country:US
Practice Address - Phone:804-924-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty