1295975027 NPI number — TRAVEL CENTER CLINICS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295975027 NPI number — TRAVEL CENTER CLINICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRAVEL CENTER CLINICS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PROFESSIONAL DRIVERS MEDICAL DEPOT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295975027
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2210 AWARD WINNING WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37932-1976
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-531-1542
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1295 HORIZON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79927-8029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-219-5087
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/06/2009

Additional Information

Authorized Official

Authorized Official Last Name:
CRABTREE
Authorized Official First Name:
MIKE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
865-531-1542

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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