Provider Demographics
NPI:1437399771
Name:TWIN CITY INTERNAL MEDICINE SPECIALISTS, INC.
Entity Type:Organization
Organization Name:TWIN CITY INTERNAL MEDICINE SPECIALISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:Y
Authorized Official - Last Name:ALBANO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:636-937-8642
Mailing Address - Street 1:PO BOX 380
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63019-0380
Mailing Address - Country:US
Mailing Address - Phone:636-937-8642
Mailing Address - Fax:636-937-9555
Practice Address - Street 1:1390 HIGHWAY 61
Practice Address - Street 2:SUITE 2200
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-4137
Practice Address - Country:US
Practice Address - Phone:636-937-8642
Practice Address - Fax:636-937-9555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001018643207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1982603650OtherNPI NUMBER FOR BENJAMIN ALBANO, JR, M.D., OWNER OF TWIN CITY INTERNAL MEDICINE
MO205427404Medicaid
MO000095272OtherMEDICARE LEGACY/PROVIDER NUMBER
MO000095272OtherMEDICARE LEGACY/PROVIDER NUMBER