1. Home
  2. Directory
  3. NPI Profile

GRAND LAKES CLINIC
NPI 1669612008
Clinic/Center - Multi-Specialty in Grand Rivers, KY

Active since February 25, 2009CLIA 18D0979196 · Microscopy
1860 J.H. O'BRYAN AVE., GRAND RIVERS, KY 42045(270) 362-8246(270) 362-9757 Get Directions Write a Review

NPPES record last updated: August 5, 2011. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Grand Lakes Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GRAND LAKES CLINIC (NPI 1669612008) is a healthcare organization registered as a multi-specialty in Grand Rivers, Kentucky and active in the NPI registry since February 2009. The organization holds a CLIA Microscopy certificate valid through April 20, 2027 and lists Mark A Edwards, Administrator//ceo, as its authorized official.

NPPES Registry Identity

NPI1669612008
Entity TypeOrganization
Primary Taxonomy261QM1300X
Legal Business NameLIVINGSTON HOSPITAL AND HEALTHCARE SERVICES, INC.
Location Address1860 J.H. O'BRYAN AVE.Grand Rivers, KY 42045
Mailing Address131 Hospital DrSalem, KY 42078-8043 · (270) 988-7296 · Fax (270) 988-3900
Phone(270) 362-8246
Fax(270) 362-9757
Organization SubpartNo
Authorized OfficialMark A EdwardsAdministrator//ceo · (270) 988-7235
Enumeration DateFebruary 25, 2009
Last NPPES UpdateAugust 5, 2011
✔ NPI 1669612008 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Multi-SpecialtyAmbulatory Health Care Facilities
Taxonomy Code261QM1300X
License✔ Licensed in KY · 900135
1860 J.H. O'BRYAN AVE., Grand Rivers, KY 42045
Open in Google Maps ↗

Other Names 1

Doing Business AsGrand Lakes Clinic

Other Identifiers 2

Medicare PIN0761701KY
Medicare PIN7617KY

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 18D0979196

Grand Lakes Clinic · Grand Rivers, KY
Active · expires Apr 20, 2027
CLIA Number18D0979196
Laboratory TypePhysician Office
Certificate Effective DateApril 21, 2025
Certificate Expiration DateApril 20, 2027
Laboratory DirectorDr. Michael P. Gavin
Laboratory Phone(270) 362-8246
Laboratory LocationGrand Lakes Clinic1860 J H O'bryan Ave, Grand Rivers, KY 42045
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Livingston Hospital And Healthcare Services, Inc.'s NPI number?

The NPI number for Livingston Hospital And Healthcare Services, Inc. is 1669612008. It was assigned to this organization in the NPPES registry on February 25, 2009. The provider is doing business as Grand Lakes Clinic.

Where is Livingston Hospital And Healthcare Services, Inc. located?

Livingston Hospital And Healthcare Services, Inc. is located at 1860 J.H. O'bryan Ave., Grand Rivers, KY 42045. The listed phone number is (270) 362-8246.

What is Livingston Hospital And Healthcare Services, Inc.'s specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Multi-Specialty, with taxonomy code 261QM1300X.

Does Livingston Hospital And Healthcare Services, Inc. hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 18D0979196) is associated with this NPI, valid through April 20, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Livingston Hospital And Healthcare Services, Inc. was last updated on August 5, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.