# TWIN LAKES PHYSICIAN GROUP PA

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710291752
- **Authorized official:** MR. RICHARD SANDVOS (CEO)
- **Authorized official phone:** (870) 425-6212

## Contact information

- **Practice address:** 17 MEDICAL PLAZA, MOUNTAIN HOME, AR 72653
- **Practice address phone:** (870) 425-6212
- **Practice address fax:** (870) 508-6896
- **Mailing address:** 17 MEDICAL PLAZA, MOUNTAIN HOME, AR 72653
- **Mailing address phone:** (870) 425-6212
- **Mailing address fax:** (870) 508-6896

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | — | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 208D00000X | General Practice Physician | — | — | Yes |
| 208VP0000X | Pain Medicine Physician | — | — | — |

## Other

- **Enumeration date:** 08/02/2010
- **Last updated:** 08/16/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 184075002 | — | AR |
| 01 | — | 5G314 | AR BC/BS | AR |
| 01 | — | DQ7170 | RAILROAD MEDICARE | AR |