Organization
TRAVIS CLINIC
Active
Other names
Canebreak Medical
Organization subpart
No
Provider details
NPI number
Authorized official
WAVERLY D BEDSOLE (OFFICE MANAGER)
(334) 289-9408
Entity
Organization
Contact information
Practice address
312 US HWY 80 E # 3, DEMOPOLIS, AL 36732-3619
(334) 289-9408
(334) 289-1160
Mailing address
PO BOX 1159, DEMOPOLIS, AL 36732-1159
(334) 289-9408
(334) 289-1160
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11061
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000082149
—
AL
01
—
51082149
BLUE CROSS BLUE SHIELD
—
Enumeration date
10/19/2007
Last updated
11/13/2025
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