MEDICARE: TRAVEL CENTER CLINICS

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	261QU0200X	Urgent Care Clinic/Center
2	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1295975027
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRAVEL CENTER CLINICS

Provider Business Mailing Address
First Line	:	2210 AWARD WINNING WAY
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37932-1976
Country	:	US
Telephone Number	:	865-531-1542
Fax Number	:

Provider Business Practice Location Address
First Line	:	1295 HORIZON BLVD
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79927-8029
Country	:	US
Telephone Number	:	915-219-5087
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. MIKE CRABTREE
Credential	:
Telephone Number	:	865-531-1542

Provider Enumeration Date	:	03/06/2009
Last Update Date	:	03/06/2009

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Directions to “TRAVEL CENTER CLINICS ” Practice Location

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