Provider Demographics
NPI:1043813603
Name:LIVINGSPRING FAMILY MEDICAL CENTER PLLC
Entity Type:Organization
Organization Name:LIVINGSPRING FAMILY MEDICAL CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOLULOPE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLABINTAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:267-640-7762
Mailing Address - Street 1:3807 E BROAD ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5623
Mailing Address - Country:US
Mailing Address - Phone:817-717-9597
Mailing Address - Fax:833-992-1938
Practice Address - Street 1:3807 E BROAD ST STE 101
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5623
Practice Address - Country:US
Practice Address - Phone:817-717-9597
Practice Address - Fax:833-992-1938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-17
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184418001Medicaid