Basic Information
| Provider Information | |||||||||
| NPI: | 1396760542 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LIVINGSTON REGIONAL HOSPITAL LLC | ||||||||
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| OtherOrganizationName: | LIVINGSTON REGIONAL HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 330 SEVEN SPRINGS WAY | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370274536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6159207000 | ||||||||
| FaxNumber: | 6159208913 | ||||||||
| Practice Location | |||||||||
| Address1: | 315 OAK ST | ||||||||
| Address2: | |||||||||
| City: | LIVINGSTON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 385701728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9318235611 | ||||||||
| FaxNumber: | 9314032334 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 03/12/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | TEAGUE | ||||||||
| AuthorizedOfficialFirstName: | KATHY | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | ASSISTANT VICE PRESIDENT, SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 6159207000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NR1301X | 0000000092 | TN | Y | Hospitals | General Acute Care Hospital | Rural |
ID Information
| ID | Type | State | Issuer | Description | 1000257 | 01 | TN | BLUE CROSS | OTHER | 01621986 | 05 | KY | MEDICAID |