Provider Demographics
NPI:1376770644
Name:TRAVIS MEDICAL SALES CORPORATION
Entity Type:Organization
Organization Name:TRAVIS MEDICAL SALES CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MATUKEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-756-2268
Mailing Address - Street 1:3201 INDUSTRIAL TERRACE #130
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-7525
Mailing Address - Country:US
Mailing Address - Phone:512-458-4589
Mailing Address - Fax:512-454-9521
Practice Address - Street 1:2910 S PADRE ISLAND DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78415-1812
Practice Address - Country:US
Practice Address - Phone:361-806-2772
Practice Address - Fax:361-806-2732
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRAVIS MEDICAL SALES CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-15
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BP3500X
TX332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition