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General NPI Number Information
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NPI Number | 1114968005
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Entity Type | Organization
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Legal Business Name | TWIN LAKES ANESTHESIOLOGY AND PAIN MANAGEMENT ASSOCIATES
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Dates
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Enumeration Date | 06/09/2006
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Last Update Date | 10/19/2007
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Provider Practice Location Address
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Address Line | 904 WALLACE AVE
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City | LEITCHFIELD
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State | KY
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Zip | 42754-1418
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Country | US
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Telephone | 270-259-9470
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Fax | 270-259-1662
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Provider Business Mailing Address
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Address Line | 904 WALLACE AVE
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City | LEITCHFIELD
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State | KY
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Zip | 42754-1418
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Country | US
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Telephone | 270-259-9470
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Fax | 270-259-1662
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. JANET L. LANGDON
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Credential |
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Telephone | 270-259-9470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | TP490
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License Number State | KY
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