Provider Demographics
NPI:1407240195
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 1:5959 SHALLOWFORD RD STE 443
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2245
Mailing Address - Country:US
Mailing Address - Phone:423-756-2268
Mailing Address - Fax:423-362-5413
Practice Address - Street 1:11436 ROJAS DR
Practice Address - Street 2:SUITE #B6
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-6471
Practice Address - Country:US
Practice Address - Phone:915-629-7174
Practice Address - Fax:915-629-7224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-20
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX016016003Medicaid
TX016016001Medicaid
TX016016004Medicaid
TX016016006Medicaid
TX016016005Medicaid
TX016016006Medicaid