Healthcare Provider Details

I. General information

NPI: 1174743702
Provider Name (Legal Business Name): TRAV-L-MED,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13131 TESSON FERRY RD SUITE 129
SAINT LOUIS MO
63128-3887
US

IV. Provider business mailing address

13131 TESSON FERRY RD SUITE 129
SAINT LOUIS MO
63128-3887
US

V. Phone/Fax

Practice location:
  • Phone: 314-842-4920
  • Fax: 314-842-3230
Mailing address:
  • Phone: 314-842-4920
  • Fax: 314-842-3230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number25858
License Number StateMO

VIII. Authorized Official

Name: DR. R(RAY) WILLIAM BURMEISTER
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 314-842-4920