Provider Demographics
NPI:1649548694
Name:LIVINGSTON CLINIC, INC.
Entity type:Organization
Organization Name:LIVINGSTON CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:RUSS
Authorized Official - Last Name:SIMPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-652-2686
Mailing Address - Street 1:107 HOSPITAL DR
Mailing Address - Street 2:PO DRAWER T
Mailing Address - City:LIVINGSTON
Mailing Address - State:AL
Mailing Address - Zip Code:35470-5742
Mailing Address - Country:US
Mailing Address - Phone:205-652-2686
Mailing Address - Fax:205-652-7093
Practice Address - Street 1:107 HOSPITAL DR
Practice Address - Street 2:PO DRAWER T
Practice Address - City:LIVINGSTON
Practice Address - State:AL
Practice Address - Zip Code:35470-5742
Practice Address - Country:US
Practice Address - Phone:205-652-2686
Practice Address - Fax:205-652-7093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5674208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000005805Medicaid
AL000005805Medicaid
000005805Medicare PIN