NPIMap

Organization Active NPI

Livingston Hospital and Healthcare Services, Inc.

Doing business as Eddyville Family Medical

  • Rural Health Clinic/Center
  • Eddyville, KY
National Provider Identifier
1386859908
Registry record updated Jun 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
LIVINGSTON HOSPITAL AND HEALTHCARE SERVICES, INC.
Doing business as
Eddyville Family Medical
Practice address
209 W Main St
Eddyville, KY 42038-7752
Phone
(270) 388-0620
Fax
(270) 388-0604
NPI assigned
May 14, 2007
Last updated
Jun 2, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Mark A Edwards
Title
Ceo
Phone
(270) 988-2299

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary
Family Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LF0000X 3006657 KY

Addresses

Primary practice location

209 W Main St
Eddyville, KY 42038-7752

Mailing address

209 W Main St
Eddyville, KY 42038-7752
Phone (270) 388-0620

Other names 1

  • Eddyville Family Medical Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031230000015 KY Part B Supplier - Clinic/Group Practice 5799692547 Receives reassigned benefits from 23 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Salem, KY; Grand Rivers, KY; Eddyville, KY; Marion, KY
O20171219001486 KY Part A Provider - Rural Health Clinic 5799692547 Practice locations: Eddyville, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386859908. Details of each certification follow.

Rural health clinic certification: CCN 183481

Legal name
LIVINGSTON HOSPITAL AND HEALTHCARE SERVICES, INC.
Doing business as
EDDYVILLE FAMILY MEDICAL
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 10, 2013
Last certification
Dec 14, 2015
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Dec 31, 1963 in KY
Enrollment address
209 W Main St
Eddyville, KY 42038-7752
Related CCNs
181320

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

727 E Main St
Salem, KY 42078
Phone (270) 988-2650

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Andrew Fox Individual Corporate DirectorBoard Member Jun 1, 2005
William Barnes Individual Corporate DirectorBoard Member May 1, 1986
James L McGregor Individual Corporate DirectorBoard Member May 1, 1995
Jim Belt Individual Corporate OfficerBoard Secretary/Treasurer May 25, 2014
Rod Whittington Individual Corporate OfficerCeo/Cfo Jan 1, 2018
Corporate DirectorCeo/Cfo Jan 1, 2018
W-2 Managing EmployeeCeo/Cfo Jan 1, 2018
Ghassan Yazigi Individual Corporate DirectorBoard Member May 25, 2014
William a Guyette Individual Corporate DirectorBoard Member Jan 1, 1986
Barry Chittenden Individual Corporate OfficerBoard Chairman May 1, 2017
Corporate DirectorBoard Member May 1, 1996
Susan Alexander Individual Corporate DirectorBoard Member Jun 1, 1999

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622592000000",
    "number": "1386859908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 W MAIN ST",
            "city": "EDDYVILLE",
            "state": "KY",
            "postal_code": "420387752",
            "telephone_number": "270-388-0620",
            "fax_number": "270-388-0604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 W MAIN ST",
            "city": "EDDYVILLE",
            "state": "KY",
            "postal_code": "420387752",
            "telephone_number": "270-388-0620",
            "fax_number": "270-388-0604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVINGSTON HOSPITAL AND HEALTHCARE SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-14",
        "last_updated": "2021-06-02",
        "certification_date": "2021-06-02",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "270-988-2299",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3006657",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eddyville Family Medical",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Eddyville Family Medical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eddyville, KY

Sources for this page

Verify at the official NPI Registry.