Provider Demographics
NPI:1700821105
Name:TRAVCO MEDICAL SUOOLIES, INC
Entity Type:Organization
Organization Name:TRAVCO MEDICAL SUOOLIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:TRAVIS
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-214-9165
Mailing Address - Street 1:340 TOM REEVES DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-4243
Mailing Address - Country:US
Mailing Address - Phone:770-214-9165
Mailing Address - Fax:770-214-7422
Practice Address - Street 1:340 TOM REEVES DR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-4243
Practice Address - Country:US
Practice Address - Phone:770-214-9165
Practice Address - Fax:770-214-7422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
3906010001Medicare NSC