Provider Demographics
NPI:1558554824
Name:J TRAVIS METHVIN, D.O, L.L.C.
Entity Type:Organization
Organization Name:J TRAVIS METHVIN, D.O, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:TRAVIS
Authorized Official - Last Name:METHVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:636-931-4913
Mailing Address - Street 1:1400 HIGHWAY 61
Mailing Address - Street 2:SUITE 240
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-4100
Mailing Address - Country:US
Mailing Address - Phone:636-931-4913
Mailing Address - Fax:636-931-4316
Practice Address - Street 1:1400 HIGHWAY 61
Practice Address - Street 2:SUITE 240
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-4100
Practice Address - Country:US
Practice Address - Phone:636-931-4913
Practice Address - Fax:636-931-4316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001014847208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty