Provider Demographics
NPI:1891976296
Name:TRAVEL CENTER CLINICS
Entity Type:Organization
Organization Name:TRAVEL CENTER CLINICS
Other - Org Name:PROFESSIONAL DRIVERS MEDICAL DEPOTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-661-8929
Mailing Address - Street 1:PO BOX 51525
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37950-1525
Mailing Address - Country:US
Mailing Address - Phone:615-661-8929
Mailing Address - Fax:615-661-8977
Practice Address - Street 1:3130 MAY RD
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IL
Practice Address - Zip Code:61354-9618
Practice Address - Country:US
Practice Address - Phone:815-224-7971
Practice Address - Fax:615-661-8977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center