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Organization
TWIN LAKES MEDICAL FOUNDATION INC
Active
Organization
TWIN LAKES MEDICAL FOUNDATION INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENEACE CLEMONS (COO)
(270) 259-1626
Entity
Organization
Contact information
Practice address
908 WALLACE AVE, LEITCHFIELD, KY 42754-1479
(270) 259-1626
(270) 259-9582
Mailing address
908 WALLACE AVE, LEITCHFIELD, KY 42754-1479
(270) 259-1626
(270) 259-9582
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
207QS0010X
Sports Medicine (Family Medicine) Physician
—
NULL
207QS0010X
Sports Medicine (Family Medicine) Physician
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
NULL
207V00000X
Obstetrics & Gynecology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
NULL
207X00000X
Orthopaedic Surgery Physician
—
—
207Y00000X
Otolaryngology Physician
—
NULL
207Y00000X
Otolaryngology Physician
—
—
208000000X
Pediatrics Physician
—
NULL
208000000X
Pediatrics Physician
—
—
2084N0400X
Neurology Physician
—
NULL
2084N0400X
Neurology Physician
—
—
208600000X
Surgery Physician
—
NULL
208600000X
Surgery Physician
—
—
208D00000X
General Practice Physician
—
NULL
208D00000X
General Practice Physician
—
—
231H00000X
Audiologist
—
NULL
231H00000X
Audiologist
—
—
363L00000X
Nurse Practitioner
Primary
—
NULL
363L00000X
Nurse Practitioner
Primary
—
—
363LA2200X
Adult Health Nurse Practitioner
—
NULL
363LA2200X
Adult Health Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
NULL
363LF0000X
Family Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
—
NULL
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
65923997
—
KY
05
—
65937047
—
KY
05
—
65937930
—
KY
05
—
65939019
—
KY
05
—
65943045
—
KY
05
—
70900162
—
KY
05
—
7100011670
—
KY
05
—
7100072530
—
KY
05
—
7100086880
—
KY
05
—
7100118990
—
KY
05
—
7100124530
—
KY
05
—
7100161750
—
KY
05
—
7100566530
—
KY
05
—
7100630070
—
KY
05
—
78903556
—
KY
Enumeration date
06/15/2006
Last updated
12/09/2019
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