Provider Demographics
NPI:1114168903
Name:TRAVEL CENTER CLINICS
Entity Type:Organization
Organization Name:TRAVEL CENTER CLINICS
Other - Org Name:PROFESSIONAL DRIVERS MEDICAL DEPOT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRABTREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:853-531-1542
Mailing Address - Street 1:2210 AWARD WINNING WAY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37932-1976
Mailing Address - Country:US
Mailing Address - Phone:865-531-1542
Mailing Address - Fax:
Practice Address - Street 1:3181 DONALD LEE HOLLOWELL PKWY NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-9002
Practice Address - Country:US
Practice Address - Phone:678-733-8301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care