Basic Information
| Provider Information | |||||||||
| NPI: | 1245654094 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LIVINGSTON HOSPITAL AND HEALTHCARE SERVICES, INC. | ||||||||
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| OtherOrganizationName: | LHHS FAMILY CARE WALK-IN CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 131 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420788043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2709882299 | ||||||||
| FaxNumber: | 2709883900 | ||||||||
| Practice Location | |||||||||
| Address1: | 131 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420788043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2709882299 | ||||||||
| FaxNumber: | 2709883900 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2014 | ||||||||
| LastUpdateDate: | 02/17/2014 | ||||||||
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| AuthorizedOfficialLastName: | EDWARDS | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2709887235 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 600071 | KY | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 207Q00000X | 600071 | KY | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.