Provider Demographics
NPI:1326756180
Name:COLUMBIA FOOT AND ANKLE CLINIC-VIRGIL GENE LIVINSTON
Entity Type:Organization
Organization Name:COLUMBIA FOOT AND ANKLE CLINIC-VIRGIL GENE LIVINSTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN-PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VIRGIL
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:LIVINGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD-DPM
Authorized Official - Phone:602-615-9915
Mailing Address - Street 1:12411 NE 70TH CIR STE 106
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-4885
Mailing Address - Country:US
Mailing Address - Phone:602-615-9915
Mailing Address - Fax:
Practice Address - Street 1:12411 NE 70TH CIR STE 106
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-4885
Practice Address - Country:US
Practice Address - Phone:602-615-9915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-10
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2228399Medicaid