Healthcare Provider Details

I. General information

NPI: 1407240195
Provider Name (Legal Business Name): TRAVIS MEDICAL SALES CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2015
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11436 ROJAS DR SUITE #B6
EL PASO TX
79936-6471
US

IV. Provider business mailing address

5959 SHALLOWFORD RD STE 443
CHATTANOOGA TN
37421-2245
US

V. Phone/Fax

Practice location:
  • Phone: 915-629-7174
  • Fax: 915-629-7224
Mailing address:
  • Phone: 423-756-2268
  • Fax: 423-362-5413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL

VIII. Authorized Official

Name: JEFFREY MATUKEWICZ
Title or Position: SECRETARY
Credential:
Phone: 423-756-2268