Provider Demographics
NPI:1447209119
Name:LIVINGSTON HOSPITAL AND HEALTHCARE SERVICES, INC., CAH
Entity Type:Organization
Organization Name:LIVINGSTON HOSPITAL AND HEALTHCARE SERVICES, INC., CAH
Other - Org Name:MARION PHYSICIAN'S CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUDNICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-988-2299
Mailing Address - Street 1:131 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:KY
Mailing Address - Zip Code:42078-8043
Mailing Address - Country:US
Mailing Address - Phone:270-988-2299
Mailing Address - Fax:270-988-3900
Practice Address - Street 1:220 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:KY
Practice Address - Zip Code:42064-1543
Practice Address - Country:US
Practice Address - Phone:270-965-4377
Practice Address - Fax:270-965-9569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY600071261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65944019Medicaid
KY65944019Medicaid
KY9745Medicare ID - Type Unspecified