Organization
LIVINGSTON PEDIATRIC CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JULIE LAIRMORE (PRACTICE ADMINISTRATOR)
(936) 328-8812
Entity
Organization
Contact information
Practice address
206 S COLLEGE AVE, CLEVELAND, TX 77327-4504
(281) 592-6000
(936) 328-8815
Mailing address
400 OGLETREE DR, LIVINGSTON, TX 77351-6783
(936) 328-8812
(936) 328-8815
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0045LZ
BCBS
TX
Enumeration date
11/02/2007
Last updated
04/20/2008
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