Healthcare Provider Details

I. General information

NPI: 1639032865
Provider Name (Legal Business Name): TWELVESTONE MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24430 STONE SPRINGS BLVD STE 515B
DULLES VA
20166-2267
US

IV. Provider business mailing address

PO BOX 12369
MURFREESBORO TN
37129-0048
US

V. Phone/Fax

Practice location:
  • Phone: 844-893-0012
  • Fax: 615-278-3355
Mailing address:
  • Phone: 615-278-3278
  • Fax: 615-278-3355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM SHANE REEVES
Title or Position: CEO
Credential: RPH
Phone: 615-278-3146