Provider Demographics
NPI:1194597070
Name:MITCHELL, TRAVIS SR
Entity type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:
Last Name:MITCHELL
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 TONYWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:WEST CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:45449-2619
Mailing Address - Country:US
Mailing Address - Phone:937-559-1245
Mailing Address - Fax:
Practice Address - Street 1:8 TONYWOOD CIR
Practice Address - Street 2:
Practice Address - City:WEST CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:45449-2619
Practice Address - Country:US
Practice Address - Phone:937-559-1245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)