Healthcare Provider Details

I. General information

NPI: 1235270612
Provider Name (Legal Business Name): TWIN RIVERS R-X
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9348 HIGHWAY 51
BROSELEY MO
63932
US

IV. Provider business mailing address

9348 HIGHWAY 51 PO BOX 146
BROSELEY MO
63932
US

V. Phone/Fax

Practice location:
  • Phone: 573-328-4321
  • Fax: 573-328-1070
Mailing address:
  • Phone: 573-328-4321
  • Fax: 573-328-1070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: MR. ANDY ARBEITMAN
Title or Position: SUPERINTENDENT
Credential:
Phone: 573-328-4321