Twin Lakes Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

TWIN LAKES SURGERY CENTER, LLC

Practice address

525 Burnett Dr
Mountain Home, AR 72653-2940

Phone

(870) 425-6213

NPI assigned

May 13, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Richard Sandvos

Title

Ceo

Phone

(870) 425-6212

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1305244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1376611200000",
    "number": "1972895613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 BURNETT DR",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726532940",
            "telephone_number": "870-425-6213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 BURNETT DR",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726532940",
            "telephone_number": "870-425-6213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TWIN LAKES SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-13",
        "last_updated": "2013-08-16",
        "status": "A",
        "authorized_official_last_name": "SANDVOS",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "870-425-6212",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "196925128",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01174719",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Belinda Rae Tucker, CPM, LM
• Karlee Tucker
• Joe Mitchell Tullis, MD
• Twin Lakes Medical Specialists, PA
• Twin Lakes Physician Group PA
• Twin River Community Living Facility
• Twin Rivers Respiratory Care, Inc.
• Elisa J. Tyler, MHPP
• Mark Ludean Ungerank, DC
• Kimberly Petkovich Vaglio, D.D.S.

• Ambulatory Surgical Clinic/Center in Mountain Home, AR
• Providers in Mountain Home, AR by specialty
• Ambulatory Surgical Clinic/Center in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.