Active NPI
Livingston Pediatric Clinic PA
- Pediatrics Physician
- Livingston, TX
National Provider Identifier
1891848297
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- Legal business name
- LIVINGSTON PEDIATRIC CLINIC PA
- Practice address
- 400 Ogletree Dr
Livingston, TX 77351-6783 - Phone
- (936) 328-8812
- Fax
- (936) 328-8815
- NPI assigned
- Jan 19, 2007
- Last updated
- Jun 19, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Marlo Brawner, MD
- Title
- Medical Director
- Phone
- (936) 328-8812
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | NU | Primary | |
| Pediatric Adolescent Medicine Physician | 2080A0000X | J6500 | TX |
Addresses
Primary practice location
400 Ogletree Dr
Livingston, TX 77351-6783
Mailing address
400 Ogletree Dr
Livingston, TX 77351-6783
Phone (936) 328-8812
Other practice location 1
203 N College Ave Ste 1001
Cleveland, TX 77327-2500
Phone (281) 592-6000
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 169920908 | Medicaid | TX | |
| 169920906 | Medicaid | TX | |
| 169920907 | Medicaid | TX | |
| 169920910 | Medicaid | TX | |
| 169920909 | Medicaid | TX | |
| 0045LZ | Other | TX | BCBS GROUP NUMBER |
| 169920905 | Medicaid | TX |
National Provider Directory
National Provider Directory- Tax ID family
- Livingston Clinic TX
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Pediatric Adolescent Medicine Physician
- Cleveland, TX
- NPI 1609055904
Locations
400 Ogletree Dr
Livingston, TX 77352
Phone (936) 328-8812
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.
-
- Pediatrics Physician
- Livingston, TX
- NPI 1033218730
-
- Pediatric Adolescent Medicine Physician
- Livingston, TX
- NPI 1548369309
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169164800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1718755200000",
"number": "1891848297",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 OGLETREE DR",
"city": "LIVINGSTON",
"state": "TX",
"postal_code": "773516783",
"telephone_number": "936-328-8812",
"fax_number": "936-328-8815"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 OGLETREE DR",
"city": "LIVINGSTON",
"state": "TX",
"postal_code": "773516783",
"telephone_number": "936-328-8812",
"fax_number": "936-328-8815"
}
],
"practiceLocations": [
{
"address_1": "203 N College Ave Ste 1001",
"address_purpose": "LOCATION",
"city": "Cleveland",
"state": "TX",
"postal_code": "773272500",
"country_code": "US",
"telephone_number": "281-592-6000",
"fax_number": "936-328-8815",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "LIVINGSTON PEDIATRIC CLINIC PA",
"organizational_subpart": "NO",
"enumeration_date": "2007-01-19",
"last_updated": "2024-06-19",
"certification_date": "2024-06-19",
"status": "A",
"authorized_official_last_name": "BRAWNER",
"authorized_official_first_name": "MARLO",
"authorized_official_title_or_position": "MEDICAL DIRECTOR",
"authorized_official_telephone_number": "936-328-8812",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NU",
"license": null,
"primary": true
},
{
"code": "2080A0000X",
"taxonomy_group": "",
"desc": "Pediatrics, Adolescent Medicine",
"state": "TX",
"license": "J6500",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "169920908",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "169920906",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "169920907",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "169920910",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "169920909",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS GROUP NUMBER",
"identifier": "0045LZ",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "169920905",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Livingston, TX
- Livingston Job Inc (Medical Rentals and Sales)
- Livingston Manor Inc (Livingston Manor)
- Livingston Manor Inc (Livingston Manor)
- Livingston Manor Inc (Livingston Manor)
- Livingston MRI, LLP (Livingston Diagnostics)
- Livingston Pharmacy LLC (Polk RX Pharmacy)
- Livingston Physical Therapy PC
- Livingston Physician Services PA
- Livingston Sleep Lab
- Livingston Smiles PLLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.