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General NPI Number Information
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NPI Number | 1366338550
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Entity Type | Organization
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Legal Business Name | TWO RIVERS PHYSICIAN SERVICES PC
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Dates
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Enumeration Date | 06/16/2025
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 401 SEWELL DR
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City | SPARTA
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State | TN
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Zip | 38583-1223
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Country | US
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Telephone | 931-738-9211
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Fax | 931-738-4180
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Provider Business Mailing Address
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Address Line | 200 CORPORATE BLVD
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City | LAFAYETTE
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State | LA
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Zip | 70508-3870
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Country | US
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Telephone | 800-893-9698
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. KENNETH HEINRICH
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Credential | MD
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Telephone | 337-609-1221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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