Organization
TRAVIS MEDICAL SALES CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY MATUKEWICZ (SECRETARY)
(423) 756-2268
Entity
Organization
Contact information
Practice address
611 W BEN WHITE BLVD, AUSTIN, TX 78704-7187
(512) 693-0452
(512) 693-0457
Mailing address
5959 SHALLOWFORD RD STE 443, CHATTANOOGA, TN 37421-2245
(423) 756-2268
(423) 362-5413
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BC3200X
Customized Equipment (DME)
Primary
0107432
TX
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
0107432
TX
332BX2000X
Oxygen Equipment & Supplies (DME)
0107432
TX
Other
Enumeration date
02/23/2009
Last updated
03/25/2021
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