Provider Demographics
NPI:1477184398
Name:THE LIVINGSTON AGENCY, PLLC
Entity Type:Organization
Organization Name:THE LIVINGSTON AGENCY, PLLC
Other - Org Name:SANCTUM MED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-248-9455
Mailing Address - Street 1:16970 DALLAS PKWY STE 500
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-1983
Mailing Address - Country:US
Mailing Address - Phone:972-248-9455
Mailing Address - Fax:972-312-1990
Practice Address - Street 1:16970 DALLAS PKWY STE 500
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1983
Practice Address - Country:US
Practice Address - Phone:972-248-9455
Practice Address - Fax:972-312-1990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-29
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty