Look up the most recent NPI and PECOS records

Mark Douglas Travis

Radiology

Allopathic & Osteopathic Physicians

PECOS Enrollment

This provider is enrolled in PECOS as MARK TRAVIS.

Based on the most recent information from CMS, provider Mark Douglas Travis is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1760455281
Provider Type
Individual
Full Name
Travis, Mark Douglas
Title
Dr.
Credential
M.D., PH.D.

Gender
Male
Sole Proprietor
No
Enumeration Date
2/8/2006
Last Updated
5/30/2023

Contact Information

Practice Location

1 Hospital Dr, Columbia, MO 65212-0001

(573) 882-1161

(573) 884-8876

Mailing Location

PO Box 843966, Kansas City, MO 64184-3966

(573) 884-3300

(573) 884-0943

Provider Taxonomies

Code	Description	License
Code 2085R0202X Primary	Description Radiology Allopathic & Osteopathic Physicians	License 2012004015 Missouri
Code 2085R0202X	Description Radiology Allopathic & Osteopathic Physicians	License 01055735A Indiana

Mark Douglas Travis

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

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