Provider Demographics
NPI:1013429372
Name:ROYAL BLUE MEDICAL TRANSPORTATION, LLC
Entity Type:Organization
Organization Name:ROYAL BLUE MEDICAL TRANSPORTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PURRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-759-7771
Mailing Address - Street 1:23300 GREENFIELD RD STE 227
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-8411
Mailing Address - Country:US
Mailing Address - Phone:248-759-7771
Mailing Address - Fax:
Practice Address - Street 1:23300 GREENFIELD RD STE 227
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-8411
Practice Address - Country:US
Practice Address - Phone:248-759-7771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5803000794343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)