Provider Demographics
NPI:1114636537
Name:TRAVIS, BURCE TAYLOR
Entity Type:Individual
Prefix:MR
First Name:BURCE
Middle Name:TAYLOR
Last Name:TRAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17303 TALFORD AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-1641
Mailing Address - Country:US
Mailing Address - Phone:216-440-2398
Mailing Address - Fax:
Practice Address - Street 1:17303 TALFORD AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-1641
Practice Address - Country:US
Practice Address - Phone:216-440-2398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)