Provider Demographics
NPI:1174743702
Name:TRAV-L-MED,LLC
Entity type:Organization
Organization Name:TRAV-L-MED,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:R(RAY)
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BURMEISTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-842-4920
Mailing Address - Street 1:13131 TESSON FERRY RD
Mailing Address - Street 2:SUITE 129
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-3887
Mailing Address - Country:US
Mailing Address - Phone:314-842-4920
Mailing Address - Fax:314-842-3230
Practice Address - Street 1:13131 TESSON FERRY RD
Practice Address - Street 2:SUITE 129
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-3887
Practice Address - Country:US
Practice Address - Phone:314-842-4920
Practice Address - Fax:314-842-3230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO25858174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty