Healthcare Provider Details

I. General information

NPI: 1245507284
Provider Name (Legal Business Name): TRAVIS MEDICAL SALES CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2011
Last Update Date: 11/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6020 MIDWAY PARK BLVD NE STE G
ALBUQUERQUE NM
87109-5842
US

IV. Provider business mailing address

1104 W 34TH ST
AUSTIN TX
78705-1908
US

V. Phone/Fax

Practice location:
  • Phone: 505-221-6015
  • Fax: 505-221-6014
Mailing address:
  • Phone: 512-489-4589
  • Fax: 512-454-9521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN YULE
Title or Position: VICE PRESIDENT
Credential:
Phone: 512-458-4589