TWIN LAKES MEDICAL FOUNDATION, INC. (NPI# 1003820812) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003820812 |
| Entity Type | Organization |
| Organization Name | TWIN LAKES MEDICAL FOUNDATION, INC. |
| Other Organization Name | WALLACE AVENUE MEDICAL CLINIC |
| Practice Address |
912 Wallace Ave Leitchfield KY 42754-2404 |
| Practice Telephone | 2702599316 |
| Practice Fax Number | 2702596571 |
| Mailing Telephone | 2702599316 |
| Mailing Fax Number | 2702596571 |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2013-06-03 |
| Authorized Official Name | LOU ELLIOTT (BUSINESS ADMINISTRATION) |
| Authorized Official Telephone | 2702599580 |
| Is Organization Subpart | Y |
| Parent Organization Name | TWIN LAKES MEDICAL FOUNDATION, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| WALLACE AVENUE MEDICAL CLINIC | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952616070 | Twin Lakes Medical Foundation, Inc. | Preventive Medicine | 1895 Elizabethtown Rd., Leitchfield, KY 42754-9138 | 2010-08-12 |
| 1053638288 | Twin Lakes Medical Foundation, Inc. | Internal Medicine | 910 Wallace Ave, Leitchfield, KY 42754-2414 | 2010-04-28 |
| 1295052975 | Twin Lakes Medical Foundation, Inc. | Nurse Practitioner | 912 Wallace Ave, Leitchfield, KY 42754-2404 | 2010-04-21 |
| 1871821454 | Twin Lakes Medical Foundation, Inc. | Internal Medicine | 912 Wallace Ave, Leitchfield, KY 42754-2404 | 2009-11-19 |
| 1275762221 | Twin Lakes Medical Foundation, Inc. | Nurse Practitioner | 9847 Elizabethtown Rd, Big Clifty, KY 42712-5880 | 2009-07-13 |
| 1730337726 | Twin Lakes Medical Foundation, Inc. | Pediatrics | 9847 Elizabethtown Rd, Big Clifty, KY 42712-5880 | 2008-09-03 |
| 1326214172 | Twin Lakes Medical Foundation, Inc. | Hearing Instrument Specialist | 910 Wallace Ave, Leitchfield, KY 42754-2414 | 2008-05-01 |
| 1861668618 | Twin Lakes Medical Foundation, Inc. | Obstetrics & Gynecology | 910 Wallace Ave, Leitchfield, KY 42754-2414 | 2008-05-01 |
| 1902982002 | Twin Lakes Medical Foundation, Inc. | Nurse Practitioner | 910 Wallace Ave, Leitchfield, KY 42754-2414 | 2006-10-31 |
| 1720164825 | Twin Lakes Medical Foundation, Inc. | Nurse Practitioner | 301 Sunset Dr, Caneyville, KY 42721-9172 | 2006-10-31 |
| Street Address |
912 WALLACE AVE |
| City | LEITCHFIELD |
| State | KY |
| Zip Code | 42754-2404 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356348213 | Charles D Jarboe | Family Medicine | 912 Wallace Ave, Suite 103, Leitchfield, KY 42754-2404 | 2005-07-06 |
| 1629611843 | Jamie M Niehaus | Nurse Practitioner | 912 Wallace Ave, Leitchfield, KY 42754-2404 | 2019-10-21 |
| 1679902753 | Kristin Anne Buck | Nurse Practitioner | 912 Wallace Ave, Leitchfield, KY 42754-2404 | 2013-11-08 |
| 1881026425 | Clay D Vincent | Nurse Practitioner | 912 Wallace Ave, Leitchfield, KY 42754-2404 | 2013-08-06 |
| 1811338858 | Cari Beth Johnson | Nurse Practitioner | 912 Wallace Ave, Leitchfield, KY 42754-2404 | 2013-07-06 |
| 1295052975 | Twin Lakes Medical Foundation, Inc. | Nurse Practitioner | 912 Wallace Ave, Leitchfield, KY 42754-2404 | 2010-04-21 |
| 1871821454 | Twin Lakes Medical Foundation, Inc. | Internal Medicine | 912 Wallace Ave, Leitchfield, KY 42754-2404 | 2009-11-19 |
| 1447473392 | Craig A. Johnson, M.d., Psc | Obstetrics & Gynecology | 912 Wallace Ave, Suite 101, Leitchfield, KY 42754-2404 | 2007-04-10 |
| 1487757134 | Gregory G. Skaggs Md | Specialist | 912 Wallace Ave, Suite 105, Leitchfield, KY 42754-2404 | 2006-09-07 |
| 1609898741 | Dinah M. Crain | Nurse Practitioner | 912 Wallace Ave, #105, Leitchfield, KY 42754-2404 | 2006-07-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750816849 | April Braun | Occupational Therapy Assistant | 121 Byrtle Grove Rd, Leitchfield, KY 42754 | 2017-04-26 |
| 1124429766 | Scott Anthony Gibson | Counselor | 805 Commerce Dr, Leitchfield, KY 42754 | 2014-09-15 |
| 1013328137 | Sandra M Dennis | Counselor | 505 O Riley St, Leitchfield, KY 42754 | 2014-05-12 |
| 1699071258 | Ellen Renae Pharis | Massage Therapist | 205 Fraim St, Leitchfield, KY 42754 | 2011-01-31 |
| 1184664096 | Joseph Michael Harris Jr. | Physical Therapist | 201 South Main Street, Leitchfield, KY 42754 | 2006-06-08 |
| 1689611469 | Joseph Michael Mulligan | Nurse Anesthetist, Certified Registered | 515 Lake Front Rd., Leitchfield, KY 42754 | 2006-06-01 |
| 1407838030 | Lincoln Trail District Health Dept | Public Health or Welfare | 124 E White Oak St, Leitchfield, KY 42754 | 2005-11-18 |
| 1487646527 | Larry Brett Abney | Optometrist | 31 Bobby Bland Way, Leitchfield, KY 42754 | 2005-08-16 |
| 1336142025 | Ted B Rogers | Orthopaedic Surgery | 908 Wallace Ave, Leitchfield, KY 42754 | 2005-05-27 |
| 1891267290 | Kristen Russell | Nurse Practitioner | 910 Wallace Ave, Leitchfield, KY 42754 | 2018-12-23 |
| Find all providers in zip 42754 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558318543 | Leitchfield Pediatric Clinic P.s.c. | Pediatrics | 901 Wallace Ave, Leitchfield, KY 42754-1417 | 2006-05-27 |
| 1215560677 | Tara Meredith | Pediatrics | 718 Goodwin Ln, Leitchfield, KY 42754-1400 | 2020-02-13 |
| 1912486887 | Jeanette Marie Jacobs | Pediatrics | 901 Wallace Ave, Leitchfield, KY 42754 | 2018-08-10 |
| 1336590678 | Rain Joelle Wells | Pediatrics | 901 Wallace Ave, Leitchfield, KY 42754-1417 | 2016-06-28 |
| 1366869208 | Elizabeth S Stivers | Pediatrics | 908 Wallace Ave, Suite 108, Leitchfield, KY 42754-1479 | 2014-03-27 |
| 1962777433 | Anthony Kurt Smith | Pediatrics | 901 Wallace Ave, Leitchfield, KY 42754-1417 | 2012-03-17 |
| 1194919902 | Tarek El Masri | Pediatrics | 901 Wallace Ave, Leitchfield, KY 42754-1417 | 2007-09-05 |
| 1023159704 | Wendee Marie Embry | Pediatrics | 901 Wallace Ave, Leitchfield, KY 42754-1417 | 2007-02-08 |
| 1518042886 | Shagufta Yousaf | Pediatrics | 908 Wallace Ave, Ste 108, Leitchfield, KY 42754 | 2006-10-26 |
| 1568409506 | Joseph Marion Lee | Pediatrics | 901 Wallace Ave, Leitchfield, KY 42754-1417 | 2006-05-31 |
| Find all providers in LEITCHFIELD | ||||
| City | LEITCHFIELD |
| Zip Code | 42754 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.