Basic Information
| Provider Information | |||||||||
| NPI: | 1093006371 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TRAVIS MEDICAL SALES CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1104 W 34TH ST | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787051908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124584589 | ||||||||
| FaxNumber: | 5124549521 | ||||||||
| Practice Location | |||||||||
| Address1: | 10421 GULFDALE ST | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782164130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2103661215 | ||||||||
| FaxNumber: | 2103661236 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2011 | ||||||||
| LastUpdateDate: | 03/15/2013 | ||||||||
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| AuthorizedOfficialLastName: | YULE | ||||||||
| AuthorizedOfficialFirstName: | JUSTIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5124584589 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | TRAVIS MEDICAL SALES CORPORATION | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BX2000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.