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General NPI Number Information
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NPI Number | 1437399771
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Entity Type | Organization
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Legal Business Name | TWIN CITY INTERNAL MEDICINE SPECIALISTS, INC.
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Dates
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Enumeration Date | 02/26/2009
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Last Update Date | 02/26/2009
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Provider Practice Location Address
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Address Line | 1390 HIGHWAY 61 SUITE 2200
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City | FESTUS
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State | MO
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Zip | 63028-4137
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Country | US
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Telephone | 636-937-8642
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Fax | 636-937-9555
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Provider Business Mailing Address
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Address Line | PO BOX 380
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City | CRYSTAL CITY
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State | MO
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Zip | 63019-0380
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Country | US
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Telephone | 636-937-8642
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Fax | 636-937-9555
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. BENJAMIN Y. ALBANO JR.
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Credential | M.D.
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Telephone | 636-937-8642
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2001018643
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License Number State | MO
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