Provider Demographics
NPI:1154418218
Name:TWELVESTONE MEDICAL, INC.
Entity type:Organization
Organization Name:TWELVESTONE MEDICAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF COMPLIANCE AND ACCREDITA
Authorized Official - Prefix:MS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARRELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-278-3278
Mailing Address - Street 1:P.O. BOX 12369
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129
Mailing Address - Country:US
Mailing Address - Phone:844-893-0012
Mailing Address - Fax:615-278-3355
Practice Address - Street 1:352 W NORTHFIELD BLVD
Practice Address - Street 2:SUITE 3A
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129
Practice Address - Country:US
Practice Address - Phone:844-893-0012
Practice Address - Fax:615-278-3355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2024-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251F00000X, 332BP3500X, 3336C0003X, 3336S0011X
TN29783336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No251F00000XAgenciesHome Infusion
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100594610Medicaid
TN1452202Medicaid
KY7100282930Medicaid
VA30015232350001Medicaid