Healthcare Provider Details

I. General information

NPI: 1720380249
Provider Name (Legal Business Name): TRAVIS INTERNATIONAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2010
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 STRAWBERRY RD
PASADENA TX
77502-5103
US

IV. Provider business mailing address

10904 SCARSDALE BLVD SUITE 350-137
HOUSTON TX
77089-6068
US

V. Phone/Fax

Practice location:
  • Phone: 713-947-6767
  • Fax: 713-947-6768
Mailing address:
  • Phone: 713-947-6767
  • Fax: 713-947-6768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number27250
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TAM NGUYEN
Title or Position: PRESIDENT
Credential:
Phone: 713-947-6767