Livingston Hospital and Healthcare Services, Inc.
Organization Active NPI Rural Health Clinic/Center · Eddyville, KY
NPI 1386859908 · NPPES record last updated Jun 2, 2021
Key facts
- NPI
- 1386859908
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- LIVINGSTON HOSPITAL AND HEALTHCARE SERVICES, INC.
- Practice address
- 209 W Main St
Eddyville, KY 42038-7752 - Phone
- (270) 388-0620
- Fax
- (270) 388-0604
- NPI assigned
- May 14, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. Mark A Edwards
- Title
- Ceo
- Phone
- (270) 988-2299
Owners & managing parties with NPI records 3
-
Ghassan Yazigi, MD
Other NPIs on the same Medicare enrollment 8
Other NPIs with the same Medicare PAC ID 5
Related certifications (CCN) 1
Practitioners 22
-
Kaitlin Loveless, APRN
-
Demetrius L Patton, M.D.
-
Samantha Samuels, APRN
-
Teresa Rae White, ARNP, FNP-BC
-
Laura Kay Wood, APRN
-
Sanjay Bose, MD
-
Bethaney Denise Long, LCSW
-
Stephanie L Mundy, APRN
-
Kristee Croft Shoulders, APRN
-
Ghassan Yazigi, MD
-
Amanda J Miley, CNS
-
Khai C Truong, M.D.
-
Eric C Brown, MD
-
Jeanie Nicole Doom, APRN
-
Misha R. Glendening, ARNP
-
Lee Ann Grainger Keller, ARNP, RN
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in KY
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
- Corporation · Non-profit
- Incorporated
- Dec 31, 1963 in KY
- Enrollment address
- 209 W Main St
Eddyville, KY 42038-7752 - Related CCNs
- 181320
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Andrew Fox |
Corporate Director |
Jun 1, 2005 | |
| William Barnes |
Corporate Director |
May 1, 1986 | |
| James L McGregor |
Corporate Director |
May 1, 1995 | |
| Jim Belt |
Corporate Officer |
May 25, 2014 | |
| Rod Whittington |
Corporate Officer |
Jan 1, 2018 | |
| Corporate Director |
Jan 1, 2018 | ||
| W-2 Managing Employee |
Jan 1, 2018 | ||
| Ghassan Yazigi |
Corporate Director |
May 25, 2014 | |
| William a Guyette |
Corporate Director |
Jan 1, 1986 | |
| Barry Chittenden |
Corporate Officer |
May 1, 2017 | |
| Corporate Director |
May 1, 1996 | ||
| Susan Alexander |
Corporate Director |
Jun 1, 1999 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes | ||
| Family Nurse Practitioner |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 78900280 | Medicaid | KY |
Other names
- Eddyville Family Medical
Other providers in Eddyville, KY
- Misha R. Glendening
- H2 Rehabilitation Services of Kentucky, LLC
- Chanin Hiland
- Kip Horstmann
- Amelia Hrapeck
- Lyon County Emergency Ambulance Service
- Lyon County Schools
- Lyon Drug Store, Inc.
- Lyon Family Dental
- Helen B. May
All providers in Eddyville, KY · Rural Health Clinic/Center in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 2, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.