NPIMap

Organization Active NPI

Livingston Hospital and Healthcare Services, Inc.

Doing business as Livingston Hospital Family Clinic

  • Rural Health Clinic/Center
  • Marion, KY
National Provider Identifier
1932920949
Registry record updated Oct 22, 2024
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
Livingston Hospital Family Clinic
Practice address
909 S Main St
Marion, KY 42064-1923
Phone
(270) 704-4131
Fax
(270) 965-2404
NPI assigned
Oct 22, 2024
Last updated
Oct 22, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2024

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

Authorized official

Name
Rod Shane Whittington
Title
Ceo
Phone
(270) 988-7236

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

909 S Main St
Marion, KY 42064-1923

Mailing address

909 S Main St
Marion, KY 42064-1923
Phone (270) 704-4131

Other names 1

  • Livingston Hospital Family Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250114002143 KY Part A Provider - Rural Health Clinic 5799692547 Practice locations: Marion, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1932920949. Details of each certification follow.

Rural health clinic certification: CCN 188570

Legal name
LIVINGSTON HOSPITAL AND HEALTHCARE SERVICES, INC.
Doing business as
LIVINGSTON HOSPITAL FAMILY CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 29, 2025
Last certification
Apr 29, 2025
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
909 S Main St
Marion, KY 42064-1923
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).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
18D2300906Livingston Hospital Family Clinic909 South Main Street, Marion, KY 42064Certificate of waiverMar 18, 2028

National Provider Directory

National Provider Directory
Tax ID family
Livingston Hospital Hea13 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.

Locations

1660 US Highway 60 W
Ledbetter, KY 42058
Phone (270) 898-1007

909 S Main St
Marion, KY 42064
Phone (270) 704-4131

Ownership & related parties

All disclosed owners & managing parties 15

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, 2024
Dan Klidzejs Individual Corporate OfficerCfo Jan 1, 2023
Corporate DirectorCfo Jan 1, 2023
W-2 Managing EmployeeCfo Jan 1, 2023
Stephen Williams Individual Corporate DirectorBoard Member Jan 1, 2024
Andrew Fox Individual Corporate DirectorBoard Member Jan 1, 2024
Marc J Florence Individual Corporate DirectorBoard Member Jan 1, 2024
William Barnes Individual Corporate DirectorBoard Member Jan 1, 2024
Daryl Michael Deguire Individual Corporate DirectorBoard Member Jan 1, 2024
Bradley W Housman Individual Corporate DirectorBoard Member Jan 1, 2024
James L McGregor Individual Corporate DirectorBoard Member Jan 1, 2024
Terry Teitloff Individual Corporate DirectorBoard Member Jan 1, 2024
Jim Belt Individual Corporate DirectorBoard Member Jan 1, 2024
Rod Whittington Individual Corporate OfficerCeo Jan 1, 2023
Corporate DirectorCeo Jan 1, 2023
W-2 Managing EmployeeCeo Jan 1, 2023
Ghassan Yazigi Individual Corporate DirectorBoard Member Jan 1, 2024
William a Guyette Individual Corporate DirectorBoard Member Jan 1, 2024
Barry Chittenden Individual Corporate DirectorBoard Member Jan 1, 2024

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 25

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 25

NPI Registry JSON

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

{
    "created_epoch": "1729555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729555200000",
    "number": "1932920949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 S MAIN ST",
            "city": "MARION",
            "state": "KY",
            "postal_code": "420641923",
            "telephone_number": "270-704-4131",
            "fax_number": "270-965-2404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 S MAIN ST",
            "city": "MARION",
            "state": "KY",
            "postal_code": "420641923",
            "telephone_number": "270-704-4131",
            "fax_number": "270-965-2404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVINGSTON HOSPITAL AND HEALTHCARE SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-22",
        "last_updated": "2024-10-22",
        "certification_date": "2024-10-22",
        "status": "A",
        "authorized_official_last_name": "WHITTINGTON",
        "authorized_official_first_name": "ROD",
        "authorized_official_middle_name": "SHANE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "270-988-7236"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Livingston Hospital Family Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marion, KY

Sources for this page

Verify at the official NPI Registry.