NPIMap

Organization Active NPI

Clinic at Royal City

  • Non-Pharmacy Dispensing Site
  • Royal City, WA
National Provider Identifier
1962586503
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
MD00010548 Issued in WA
Legal business name
CLINIC AT ROYAL CITY
Practice address
101 Camelia St NW
Royal City, WA 99357
Phone
(509) 346-1447
Fax
(509) 346-1481
NPI assigned
Oct 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Direndia Shackelford
Title
Managed Care Specialist
Phone
(800) 654-0889

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X MD00010548 WA Primary

Addresses

Primary practice location

101 Camelia St NW
Royal City, WA 99357

Mailing address

PO Box 1028
Royal City, WA 99357-1028

Other identifiers 2

IdentifierTypeStateIssuer
8213605MedicaidWA
4928137OtherOTHER ID NUMBER-COMMERCIAL NUMBER

Other names 1

  • CLINIC AT ROYAL CITY Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1962586503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1028",
            "city": "ROYAL CITY",
            "state": "WA",
            "postal_code": "993571028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 CAMELIA ST NW",
            "city": "ROYAL CITY",
            "state": "WA",
            "postal_code": "99357",
            "telephone_number": "509-346-1447",
            "fax_number": "509-346-1481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINIC AT ROYAL CITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SHACKELFORD",
        "authorized_official_first_name": "DIRENDIA",
        "authorized_official_title_or_position": "MANAGED CARE SPECIALIST",
        "authorized_official_telephone_number": "800-654-0889"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "WA",
            "license": "MD00010548",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8213605",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "4928137",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CLINIC AT ROYAL CITY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Royal City, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.