NPIMap

Organization Active NPI

Livingston Hospital and Healthcare Services, Inc.

  • Critical Access Hospital
  • Salem, KY
National Provider Identifier
1730165416
Registry record updated Dec 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
600071 Issued in KY
Legal business name
LIVINGSTON HOSPITAL AND HEALTHCARE SERVICES, INC.
Practice address
131 Hospital Dr
Salem, KY 42078-8043
Phone
(270) 988-2299
Fax
(270) 988-3900
NPI assigned
Dec 15, 2005
Last updated
Dec 4, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2014

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

Authorized official

Name
Mr. Mark A Edwards
Title
Chief Executive Officer
Phone
(270) 988-2299

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 600071 KY Primary

Addresses

Primary practice location

131 Hospital Dr
Salem, KY 42078-8043

Mailing address

131 Hospital Dr
Salem, KY 42078-8043
Phone (270) 988-2299

Other identifiers 1

IdentifierTypeStateIssuer
12700654MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071211000772 KY Part A Provider - Critical Access Hospital 5799692547 Receives reassigned benefits from 2 practitioners
Practice locations: Salem, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1730165416. Details of each certification follow.

Hospital certification: CCN 18Z320

Legal name
LIVINGSTON HOSPITAL AND HEALTHCARE SERVICES, INC.
Organization structure
CorporationNon-profit
Incorporated
Jan 31, 1964 in KY
Enrollment address
131 Hospital Dr
Salem, KY 42078-8043
Hospital Swing-Bed Unit

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).

National Provider Directory

National Provider Directory
Tax ID family
Livingston Hospital and Healthcare Services Inc13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
William a White Individual Corporate DirectorBoard Member Jan 1, 2025
Stephen Williams Individual Corporate DirectorBoard Member Jan 1, 2025
Andrew Fox Individual Corporate DirectorBoard Member Jun 1, 2005
Marc J Florence Individual Corporate DirectorBoard Member Jan 1, 2025
Marcille Mahan Individual Corporate DirectorBoard Member May 1, 2015
William Barnes Individual Corporate DirectorBoard Member May 1, 1986
Daryl Michael Deguire Individual Corporate DirectorBoard Member Jan 1, 2025
James L McGregor Individual Corporate DirectorBoard Member May 1, 1995
Terry Teitloff Individual Corporate DirectorBoard Member Jan 1, 2025
Joseph W Prather Individual Corporate DirectorBoard Member Jan 1, 2025
Jim Belt Individual Corporate OfficerBoard Secretary/Treasurer May 24, 2014
Corporate DirectorBoard Member May 24, 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 4

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

Practitioners & affiliated clinicians

Practitioners 2

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.

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1134604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417651200000",
    "number": "1730165416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "131 HOSPITAL DR",
            "city": "SALEM",
            "state": "KY",
            "postal_code": "420788043",
            "telephone_number": "270-988-2299",
            "fax_number": "270-988-3900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "131 HOSPITAL DR",
            "city": "SALEM",
            "state": "KY",
            "postal_code": "420788043",
            "telephone_number": "270-988-2299",
            "fax_number": "270-988-3900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVINGSTON HOSPITAL AND HEALTHCARE SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-15",
        "last_updated": "2014-12-04",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "270-988-2299",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "KY",
            "license": "600071",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "12700654",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, KY

Sources for this page

Verify at the official NPI Registry.