# SIXTY FOURTH STREET LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164538286
- **Authorized official:** ANDREW LIVINGSTON MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (616) 685-3975

## Contact information

- **Practice address:** 2373 64TH ST SW, SUITE 2200, BYRON CENTER, MI 49315-7974
- **Practice address phone:** (616) 685-3975
- **Practice address fax:** (616) 685-3977
- **Mailing address:** 2373 64TH ST SW, SUITE 2200, BYRON CENTER, MI 49315-7974
- **Mailing address phone:** (616) 685-3975
- **Mailing address fax:** (616) 685-3977

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 08/22/2006
- **Last updated:** 04/23/2018