=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841683588
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIVINGSTON HEALTHCARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2015
-----------------------------------------------------
Last Update Date | 01/03/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 309 ELLIOT STREET NORTH
-----------------------------------------------------
City | WILSALL
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59086-0347
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-578-2580
-----------------------------------------------------
Fax | 406-578-2582
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 320 ALPENGLOW LANE
-----------------------------------------------------
City | LIVINGSTON
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-578-2580
-----------------------------------------------------
Fax | 406-823-6287
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | BREN LOWE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 406-823-6411
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number | 12556
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------