Travis Edward Tweedy
Individual provider Active NPI Contractor · Carlyle, IL
NPI 1245102409 · NPPES record last updated Sep 18, 2025
Key facts
- NPI
- 1245102409
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- Practice address
- 10700 Old State Rd
Carlyle, IL 62231-6502 - Phone
- (618) 795-0351
- NPI assigned
- Sep 18, 2025
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | IL | Yes |
Addresses
Primary practice location
10700 Old State Rd
Carlyle, IL 62231-6502
Mailing address
10700 Old State Rd
Carlyle, IL 62231-6502
Phone (618) 795-0351
Other providers in Carlyle, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 18, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.