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General NPI Number Information
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NPI Number | 1457681298
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Entity Type | Organization
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Legal Business Name | TRAVIS MEDICAL SALES CORPORATION
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Dates
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Enumeration Date | 12/29/2009
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Last Update Date | 03/25/2021
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Provider Practice Location Address
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Address Line | 1724 SUNSET DR
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City | SAN ANGELO
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State | TX
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Zip | 76904-7104
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Country | US
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Telephone | 325-223-6400
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Fax | 325-223-6404
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Provider Business Mailing Address
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Address Line | 5959 SHALLOWFORD RD STE 443
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City | CHATTANOOGA
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State | TN
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Zip | 37421-2245
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Country | US
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Telephone | 423-756-2268
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Fax | 423-362-5413
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Authorized Official
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Title or Position | SECRETARY
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Name | JEFFREY MATUKEWICZ
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Credential |
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Telephone | 423-756-2268
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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