Healthcare Provider Details

I. General information

NPI: 1710081039
Provider Name (Legal Business Name): LIVINGSTONHEALTHCARE CRNA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 ALPENGLOW LN
LIVINGSTON MT
59047-8506
US

IV. Provider business mailing address

320 ALPENGLOW LN
LIVINGSTON MT
59047-8506
US

V. Phone/Fax

Practice location:
  • Phone: 406-222-3541
  • Fax: 406-222-5034
Mailing address:
  • Phone: 406-222-3541
  • Fax: 406-222-5034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number10657
License Number StateMT

VIII. Authorized Official

Name: BREN LOWE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 406-222-5011