MEDICARE: TRAVIS D FIELDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1295510527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRAVIS D FIELDS

Provider Business Mailing Address
First Line	:	62895 HAMBY RD
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-9575
Country	:	US
Telephone Number	:	541-389-1409
Fax Number	:

Provider Business Practice Location Address
First Line	:	2125 NE DAGGETT LN
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-6560
Country	:	US
Telephone Number	:	541-408-7293
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2023
Last Update Date	:	08/25/2023

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