Provider Demographics
NPI:1881705853
Name:LIVINGSTONHEALTHCARE RADIOLOGY-LOCUM
Entity type:Organization
Organization Name:LIVINGSTONHEALTHCARE RADIOLOGY-LOCUM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:PLESHAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-222-5011
Mailing Address - Street 1:504 S 13TH ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047-3727
Mailing Address - Country:US
Mailing Address - Phone:406-222-3541
Mailing Address - Fax:406-222-5034
Practice Address - Street 1:504 S 13TH ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047-3727
Practice Address - Country:US
Practice Address - Phone:406-222-3541
Practice Address - Fax:406-222-5034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10657282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000094065OtherBLUECROSSBLUESHIELD