MEDICARE: LIVINGSTON HOSPITAL AND HEALTHCARE SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center	900135	KY

General Provider Information

NPI Number	:	1669612008
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVINGSTON HOSPITAL AND HEALTHCARE SERVICES, INC.

Provider Business Mailing Address
First Line	:	131 HOSPITAL DR
Second Line	:
City	:	SALEM
State	:	KY
Zip	:	42078-8043
Country	:	US
Telephone Number	:	270-988-7296
Fax Number	:	270-988-3900

Provider Business Practice Location Address
First Line	:	1860 J.H. O'BRYAN AVE.
Second Line	:
City	:	GRAND RIVERS
State	:	KY
Zip	:	42045
Country	:	US
Telephone Number	:	270-362-8246
Fax Number	:	270-362-9757

Authorized Official
Title or Position	:	ADMINISTRATOR//CEO
Name	:	MR. MARK A EDWARDS
Credential	:
Telephone Number	:	270-988-7235

Provider Enumeration Date	:	02/25/2009
Last Update Date	:	08/05/2011

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