Provider Demographics
NPI:1588279087
Name:ROYALTY HEALTHCARE INCORPORATED
Entity type:Organization
Organization Name:ROYALTY HEALTHCARE INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:386-344-1422
Mailing Address - Street 1:4846 NW LAKE JEFFERY RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-4797
Mailing Address - Country:US
Mailing Address - Phone:386-344-1422
Mailing Address - Fax:
Practice Address - Street 1:881 BENDING OAK TRL
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-2457
Practice Address - Country:US
Practice Address - Phone:386-344-1422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROYALTY HEALTHCARE INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-10
Last Update Date:2022-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107980200Medicaid