Provider Demographics
NPI:1497007157
Name:MED TRAVELERS
Entity Type:Organization
Organization Name:MED TRAVELERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COTA
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CAMPOS
Authorized Official - Suffix:
Authorized Official - Credentials:ASSOCIATES OF SCIENC
Authorized Official - Phone:936-933-7719
Mailing Address - Street 1:415 MONTROSE ST
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75901-0439
Mailing Address - Country:US
Mailing Address - Phone:936-933-7719
Mailing Address - Fax:
Practice Address - Street 1:415 MONTROSE ST
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75901-0439
Practice Address - Country:US
Practice Address - Phone:936-933-7719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210374314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility