Healthcare Provider Details

I. General information

NPI: 1992265128
Provider Name (Legal Business Name): TWIN RIVERS RESPIRATORY CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2519 MILITARY RD STE B
BENTON AR
72015-2441
US

IV. Provider business mailing address

3325 BARTLETT BLVD
ORLANDO FL
32811-6428
US

V. Phone/Fax

Practice location:
  • Phone: 501-443-1888
  • Fax: 501-574-3031
Mailing address:
  • Phone: 407-206-0040
  • Fax: 407-206-0010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN P GRIGGS
Title or Position: CEO
Credential:
Phone: 407-206-0040