Healthcare Provider Details

I. General information

NPI: 1083650584
Provider Name (Legal Business Name): LIVINGSTON REGIONAL HOSPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 OAK ST
LIVINGSTON TN
38570-1728
US

IV. Provider business mailing address

680 S 4TH ST
LOUISVILLE KY
40202-2407
US

V. Phone/Fax

Practice location:
  • Phone: 931-823-5611
  • Fax: 931-403-2334
Mailing address:
  • Phone:
  • Fax: 502-212-8481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: JOHNETTA TRAYLOR
Title or Position: DIRECTOR LICENSE AND CERTIFICATION
Credential:
Phone: 502-596-6063