1770768129 NPI number — ROYAL DAVY, LLC

Table of content: (NPI 1770768129)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770768129 NPI number — ROYAL DAVY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROYAL DAVY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770768129
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
54 SUGAR CREEK CENTER BLVD
Provider Second Line Business Mailing Address:
300
Provider Business Mailing Address City Name:
SUGAR LAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77478-4064
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-886-2758
Provider Business Mailing Address Fax Number:
832-886-2858

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
54 SUGAR CREEK CENTER BLVD
Provider Second Line Business Practice Location Address:
300
Provider Business Practice Location Address City Name:
SUGAR LAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77478-4064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-886-2758
Provider Business Practice Location Address Fax Number:
832-886-2858
Provider Enumeration Date:
01/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
AL-NAIMI
Authorized Official First Name:
ABDULRAHMAN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT AND CHIEF MEDICAL OFFICER
Authorized Official Telephone Number:
832-886-2758

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  K0594 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0038DH . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 85450Z . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8F4130 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1777819 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 142683501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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