Provider Demographics
NPI:1477749638
Name:ROBERT E LIVINGSTON III MD LLC
Entity type:Organization
Organization Name:ROBERT E LIVINGSTON III MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:LIVINGSTON
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:803-276-0004
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29108-0130
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2624 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:SC
Practice Address - Zip Code:29108-4002
Practice Address - Country:US
Practice Address - Phone:803-276-0004
Practice Address - Fax:803-276-0006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC050830Medicaid
SCDE9043OtherRAILROAD MEDICARE
SC5609260001Medicare NSC
SC050830Medicaid
SC8418Medicare PIN
SCD182518418Medicare UPIN