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General NPI Number Information
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NPI Number | 1902095565
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Entity Type | Organization
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Legal Business Name | TRAVIS CLINIC
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Dates
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Enumeration Date | 10/19/2007
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 312 US HWY 80 E # 3
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City | DEMOPOLIS
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State | AL
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Zip | 36732-3619
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Country | US
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Telephone | 334-289-9408
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Fax | 334-289-1160
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Provider Business Mailing Address
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Address Line | PO BOX 1159
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City | DEMOPOLIS
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State | AL
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Zip | 36732-1159
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Country | US
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Telephone | 334-289-9408
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Fax | 334-289-1160
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | WAVERLY D BEDSOLE
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Credential |
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Telephone | 334-289-9408
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 11061
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License Number State | AL
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