MEDICARE: TRAVIS MEDICAL SALES CORPORATION

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
1	332BC3200X	Customized Equipment (DME)		TX
2	332B00000X	Durable Medical Equipment & Medical Supplies		TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	514771	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1619971025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRAVIS MEDICAL SALES CORPORATION

Provider Business Mailing Address
First Line	:	5959 SHALLOWFORD RD STE 443
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-2245
Country	:	US
Telephone Number	:	423-756-2268
Fax Number	:	423-362-5413

Provider Business Practice Location Address
First Line	:	8 N 21ST ST
Second Line	:
City	:	TEMPLE
State	:	TX
Zip	:	76504-2532
Country	:	US
Telephone Number	:	512-458-4589
Fax Number	:	512-454-9521

Authorized Official
Title or Position	:	SECRETARY
Name	:	MR. JEFFREY MATUKEWICZ
Credential	:
Telephone Number	:	423-756-2268

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	02/05/2025

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Directions to “TRAVIS MEDICAL SALES CORPORATION ” Practice Location

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