Organization
TWIN LAKES SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD SANDVOS (CEO)
(870) 425-6212
Entity
Organization
Contact information
Practice address
525 BURNETT DR, MOUNTAIN HOME, AR 72653-2940
(870) 425-6213
Mailing address
525 BURNETT DR, MOUNTAIN HOME, AR 72653-2940
(870) 425-6213
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
196925128
—
AR
01
—
P01174719
RAILROAD MEDICARE
AR
Enumeration date
05/13/2011
Last updated
08/16/2013
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