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NPI Code Detail

MEDICARE: MR. TRAVIS SANDERS ROSS PA-C

MEDICARE: MR. TRAVIS SANDERS ROSS PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant001000298NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1578520417
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TRAVIS SANDERS ROSS PA-C
Provider Business Mailing Address
First Line : 3622 N MAIN ST
Second Line :
City : HOPE MILLS
State : NC
Zip : 28348-1937
Country : US
Telephone Number : 910-423-7771
Fax Number : 910-423-4177
Provider Business Practice Location Address
First Line : 3622 N MAIN ST
Second Line :
City : HOPE MILLS
State : NC
Zip : 28348-1937
Country : US
Telephone Number : 910-423-7771
Fax Number : 910-423-4177
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2006
Last Update Date : 06/10/2024

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