MEDICARE: TWIN LAKES FAMILY PRACTICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	14881	KY

General Provider Information

NPI Number	:	1780876581
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TWIN LAKES FAMILY PRACTICE

Provider Business Mailing Address
First Line	:	PO BOX 158
Second Line	:
City	:	CLARKSON
State	:	KY
Zip	:	42726-0158
Country	:	US
Telephone Number	:	270-242-2311
Fax Number	:

Provider Business Practice Location Address
First Line	:	625 W MAIN ST
Second Line	:
City	:	CLARKSON
State	:	KY
Zip	:	42726-7044
Country	:	US
Telephone Number	:	270-242-2311
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. VICTOR F DUVALL
Credential	:	MD
Telephone Number	:	270-242-2311

Provider Enumeration Date	:	08/15/2007
Last Update Date	:	08/15/2007

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Directions to “TWIN LAKES FAMILY PRACTICE ” Practice Location

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