=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649548694
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIVINGSTON CLINIC, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2011
-----------------------------------------------------
Last Update Date | 12/06/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 107 HOSPITAL DR PO DRAWER T
-----------------------------------------------------
City | LIVINGSTON
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35470-5742
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-652-2686
-----------------------------------------------------
Fax | 205-652-7093
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 107 HOSPITAL DR PO DRAWER T
-----------------------------------------------------
City | LIVINGSTON
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35470-5742
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-652-2686
-----------------------------------------------------
Fax | 205-652-7093
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. WILLIAM RUSS SIMPKINS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 205-652-2686
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | 5674
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------