Healthcare Provider Details

I. General information

NPI: 1326756180
Provider Name (Legal Business Name): COLUMBIA FOOT AND ANKLE CLINIC-VIRGIL GENE LIVINSTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2022
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12411 NE 70TH CIR STE 106
VANCOUVER WA
98682-4885
US

IV. Provider business mailing address

12411 NE 70TH CIR STE 106
VANCOUVER WA
98682-4885
US

V. Phone/Fax

Practice location:
  • Phone: 602-615-9915
  • Fax:
Mailing address:
  • Phone: 602-615-9915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. VIRGIL GENE LIVINGSTON
Title or Position: PHYSICIAN-PODIATRIST
Credential: MD-DPM
Phone: 602-615-9915