Provider Demographics
NPI:1174701916
Name:LIVINGSTON AFTER HOURS & OCCUPATIONAL MEDICINE LLC
Entity type:Organization
Organization Name:LIVINGSTON AFTER HOURS & OCCUPATIONAL MEDICINE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SKIP
Authorized Official - Middle Name:KELLY
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP-C
Authorized Official - Phone:225-000-0000
Mailing Address - Street 1:PO BOX 1567
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:LA
Mailing Address - Zip Code:70754-1567
Mailing Address - Country:US
Mailing Address - Phone:225-686-1114
Mailing Address - Fax:225-686-1115
Practice Address - Street 1:14292 FLORIDA BOULEVARD
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:LA
Practice Address - Zip Code:70754
Practice Address - Country:US
Practice Address - Phone:225-686-1114
Practice Address - Fax:225-686-1115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2008-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty