# MASSVAX TRAVEL CLINIC L.L.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265450282
- **Authorized official:** MR. RAY CHARLES THOMPSON R.R.T. (RESPIRATORY THERAPIST)
- **Authorized official phone:** (334) 790-2260

## Contact information

- **Practice address:** 113 PARKSIDE DR, HEADLAND, AL 36345-1520
- **Practice address phone:** (334) 790-2260
- **Mailing address:** 113 PARKSIDE DR, HEADLAND, AL 36345-1520
- **Mailing address phone:** (334) 790-2260

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 335V00000X | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | — | NULL | Yes |

## Other

- **Enumeration date:** 07/17/2006
- **Last updated:** 08/22/2020