Provider Demographics
NPI:1114968005
Name:TWIN LAKES ANESTHESIOLOGY AND PAIN MANAGEMENT ASSOCIATES
Entity Type:Organization
Organization Name:TWIN LAKES ANESTHESIOLOGY AND PAIN MANAGEMENT ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:L
Authorized Official - Last Name:LANGDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-259-9470
Mailing Address - Street 1:904 WALLACE AVE
Mailing Address - Street 2:
Mailing Address - City:LEITCHFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42754-1418
Mailing Address - Country:US
Mailing Address - Phone:270-259-9470
Mailing Address - Fax:270-259-1662
Practice Address - Street 1:904 WALLACE AVE
Practice Address - Street 2:
Practice Address - City:LEITCHFIELD
Practice Address - State:KY
Practice Address - Zip Code:42754-1418
Practice Address - Country:US
Practice Address - Phone:270-259-9470
Practice Address - Fax:270-259-1662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP490207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50011448OtherPASSPORT
KY000000485100OtherBLUE PREFERRED
KY274629400OtherPASSPORT ADVANTAGE
KY274629400OtherPASSPORT ADVANTAGE