Provider Demographics
NPI:1851531677
Name:TRAVEL CENTER CLINICS
Entity Type:Organization
Organization Name:TRAVEL CENTER CLINICS
Other - Org Name:PROFESSIONAL DRIVERS MEDICAL DEPOT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRABTREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-531-1542
Mailing Address - Street 1:2210 AWARD WINNING WAY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37932-1976
Mailing Address - Country:US
Mailing Address - Phone:865-531-1542
Mailing Address - Fax:
Practice Address - Street 1:1010 BELTWAY PKWY
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-3626
Practice Address - Country:US
Practice Address - Phone:956-790-8661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care