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Travis David Wilson

Anesthesiology

Allopathic & Osteopathic Physicians

4502 Medical Dr, San Antonio, TX 78229-4402

PECOS Enrollment

This provider is enrolled in PECOS as TRAVIS WILSON.

Based on the most recent information from CMS, provider Travis David Wilson is legally eligible to order and refer claims for DME and PMD services only.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 11:51 AM.

Profile Details

Provider ID
1154532729
Provider Type
Individual
Full Name
Wilson, Travis David
Title
Dr.
Credential
M.D.

Gender
Male
Sole Proprietor
No
Enumeration Date
5/25/2007
Last Updated
6/29/2011

Contact Information

Practice Location

4502 Medical Dr, San Antonio, TX 78229-4402

(210) 450-9000

Unlisted Fax

Mailing Location

7703 Floyd Curl Dr, San Antonio, TX 78229-3901

(210) 450-9000

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 207L00000X Primary	Description Anesthesiology Allopathic & Osteopathic Physicians	License N6770 Texas
Code 207L00000X	Description Anesthesiology Allopathic & Osteopathic Physicians	License 01058872A Indiana

Provider Identifiers

ID	Description	Issuer
ID 220554401	Description Medicaid	Issuer Unlisted Texas

Travis David Wilson

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Anestexia Llc

Gutierrez, Olivia

Clanton, David B.

Freeman, Rachel Michelle

Yulda, David

Solomon, Stuart

Elenes, Rafael

Wenzel, Michael P

Ronald Gotanco P.A.

Bent, Sabrina T.