LICKING MEMORIAL PROFESSIONAL CORP. (NPI# 1326068768) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326068768 |
| Entity Type | Organization |
| Organization Name | LICKING MEMORIAL PROFESSIONAL CORP. |
| Other Organization Name | LICKING MEMORIAL PULMONOLOGY |
| Practice Address |
1320 West Main Street Newark OH 43055-1822 |
| Practice Telephone | 7403481805 |
| Practice Fax Number | 7403481806 |
| Mailing Telephone | 7403481805 |
| Mailing Fax Number | 7403481806 |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2010-11-12 |
| Authorized Official Name | CYNTHIA L. WEBSTER (VP FINANCIAL SERVICES) |
| Authorized Official Telephone | 7403484027 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RP1001X |
Internal Medicine Specialization: Pulmonary Disease |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Licking Memorial Pulmonology | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235311358 | Licking Memorial Professional Corp. | Family Medicine | 17 Forry St, Newark, OH 43055-4004 | 2007-11-30 |
| 1497771521 | Licking Memorial Professional Corp. | Pediatrics | 240 N. Main St, Utica, OH 43080 | 2006-07-14 |
| 1689690661 | Licking Memorial Professional Corp. | Family Medicine | 96 Integrity Drive, H., Hebron, OH 43025 | 2006-07-14 |
| 1487688545 | Licking Memorial Professional Corp. | Family Medicine | 687 Hopewell Dr, Suite2, Heath, OH 43056-1579 | 2006-07-11 |
| 1598945818 | Licking Memorial Professional Corp. | Family Medicine | 717 S 30th St, Newark, OH 43056-1244 | 2007-11-05 |
| 1669547824 | Licking Memorial Professional Corp. | Pediatrics | 399 E Main St, Newark, OH 43055-6516 | 2006-11-22 |
| 1154496503 | Licking Memorial Professional Corp. | General Practice | 2000 Tamarack Rd, Newark, OH 43055 | 2006-11-21 |
| 1295809614 | Licking Memorial Professional Corp. | Psychiatry & Neurology | 1 Healthy Pl, Suite 105, Pataskala, OH 43062-7067 | 2006-11-17 |
| 1649290073 | Licking Memorial Professional Corp. | Internal Medicine | 120 Mcmillen Dr, Newark, OH 43055-1809 | 2006-07-20 |
| 1235159674 | Licking Memorial Professional Corp. | Obstetrics & Gynecology | 1 Healthy Pl, Suite 103, Pataskala, OH 43062-7067 | 2006-07-20 |
| Street Address |
1320 WEST MAIN STREET |
| City | NEWARK |
| State | OH |
| Zip Code | 43055-1822 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942200993 | Rebecca Thomas | Nurse Anesthetist, Certified Registered | 1320 West Main Street, Newark, OH 43055 | 2005-07-29 |
| 1679079016 | Megan Marie Lowry | Nurse Practitioner | 1320 West Main Street, Newark, OH 43055 | 2018-04-04 |
| 1104206564 | Brendan Divis | Anesthesiology | 1320 West Main Street, Newark, OH 43055 | 2015-06-01 |
| 1366862906 | Andrew Reaven | Anesthesiology | 1320 West Main Street, Newark, OH 43055-1822 | 2014-04-22 |
| 1518302066 | Leah Thornton | Anesthesiology | 1320 West Main Street, Newark, OH 43055 | 2013-05-09 |
| 1780926337 | John Peter Lazar | Pediatrics | 1320 West Main Street, Newark, OH 43055 | 2013-03-21 |
| 1669713483 | Brian F Goodhue | Emergency Medicine | 1320 West Main Street, Newark, OH 43055 | 2013-03-04 |
| 1760732374 | Amanda Sofia Davila Rodriguez | Pediatrics | 1320 West Main Street, Newark, OH 43055 | 2012-09-12 |
| 1124373535 | Jason D Carrier | Nurse Anesthetist, Certified Registered | 1320 West Main Street, Newark, OH 43055 | 2012-07-23 |
| 1033484548 | Deforest Roche Brown | Nurse Anesthetist, Certified Registered | 1320 West Main Street, Newark, OH 43055 | 2012-03-16 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770125585 | Jessica Danielle Dunkle | Case Manager/Care Coordinator | 15 N 3rd Street Suite 300, Newark, OH 43055 | 2019-10-14 |
| 1558910331 | Diana Cleland | Home Health Aide | 25 Western Rd, Apartment A, Newark, OH 43055 | 2019-09-05 |
| 1912424789 | Sandra Lou Fraley | Community/Behavioral Health | 15 North 3rd Street, Suite 300, Newark, OH 43055 | 2017-08-23 |
| 1215450911 | Caitlyn Thella Smith Elkins | Social Worker | 15 N. 3rd St., Newark, OH 43055 | 2017-07-25 |
| 1992227888 | Sierra Elizabeth Donley | Student in an Organized Health Care Education/Training Program | 140 W Church St, Newark, OH 43055 | 2017-07-12 |
| 1386170587 | Patricia Louise Fischer | Pharmacist | 1155 North 21rst Street, Newark, OH 43055 | 2017-05-08 |
| 1689120958 | Bebout Services, LLC | Home Health | 1325 Dayton Road Ne, Newark, OH 43055 | 2016-08-28 |
| 1750834594 | Laura Smith | Registered Nurse | 1445 West Main Street, Suite B, Newark, OH 43055 | 2016-07-28 |
| 1164807277 | Frank Kobe | Psychologist | 116 N. 21st Street, Newark, OH 43055 | 2015-07-30 |
| 1770975898 | Gentle Foot Care, Inc | Podiatrist | 1271 W Main Street, Bldg 1, Newark, OH 43055 | 2015-02-26 |
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| Taxonomy Code | 207RP1001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Pulmonary Disease |
| An internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational and environmental diseases, bronchitis, sleep disorders, emphysema and other complex disorders of the lungs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063654135 | Deirdre Colgan | Internal Medicine | 1200 Driving Park Avenue, Po Box 111, Newark, NY 14513-1090 | 2009-04-03 |
| 1467536623 | Pulmonary & Critical Care Associates | Internal Medicine | 268-306 Dr M.l.k. Blvd, Newark, NJ 07102 | 2006-10-24 |
| 1124109319 | Richard A. Miller | Internal Medicine | 268 -306 Martin Luther King Blvd, Newark, NJ 07102 | 2006-10-17 |
| 1871512616 | Saroj Sehgal | Internal Medicine | 1023 S Orange Ave, Newark, NJ 07106-1718 | 2006-07-19 |
| 1205851359 | Lee B. Reichman | Internal Medicine | 225 Warren St, 1st Floor, Newark, NJ 07103-3535 | 2006-07-12 |
| 1932178357 | Hemantkumar G Patel | Internal Medicine | 646 Sanford Ave, Newark, NJ 07106-3036 | 2006-03-16 |
| 1346669496 | Carlos E Osorio | Internal Medicine | 150 Bergen St, Newark, NJ 07103-2496 | 2014-04-15 |
| 1124445200 | Katherine Chiapaikeo-poco | Internal Medicine | 201 Lyons Ave, Newark, NJ 07112-2027 | 2014-03-26 |
| 1891138236 | Marc Isaiah Lindner | Internal Medicine | 201 Lyons Ave, Newark, NJ 07112-2027 | 2013-04-16 |
| 1225320427 | Andrew Ryan Deitchman | Internal Medicine | 4755 Ogletown Stanton Rd, Newark, DE 19718-0001 | 2011-05-05 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.