LICKING MEMORIAL PROFESSIONAL CORP.


Address: 1272 W Main St, Bldg. 3, Newark, OH 43055-2004
Phone: 7403481880

LICKING MEMORIAL PROFESSIONAL CORP. (NPI# 1366461386) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1366461386
Entity Type Organization
Organization Name LICKING MEMORIAL PROFESSIONAL CORP.
Other Organization Name LICKING MEMORIAL SURGICAL SERVICES
Practice Address 1272 W Main St
Bldg. 3
Newark
OH 43055-2004
Practice Telephone 7403481880
Practice Fax Number 7403481881
Mailing Telephone 7403481880
Mailing Fax Number 7403481881
Enumeration Date 2006-07-19
Last Update Date 2020-08-22
Authorized Official Name ROBERT A. MONTAGNESE (EXECUTIVE V.P.)
Authorized Official Telephone 7403484000
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 208600000X Surgery Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
OH 2483610 05

Other Provider/Organization Names

Other Name Type Code
Licking Memorial Surgical Services Doing Business As Name - Organization

Other Provider IDs and Locations

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
1326068768 Licking Memorial Professional Corp. Internal Medicine 1320 West Main Street, Newark, OH 43055-1822 2006-07-20

Office Location

Street Address 1272 W MAIN ST
BLDG. 3
City NEWARK
State OH
Zip Code 43055-2004

Providers in the same location

NPI Name Taxonomy Address Enumeration
1043218068 Carl Waggoner Family Medicine 1272 W Main St, Bldg. 5, Newark, OH 43055-2034 2005-07-13
1073822938 Licking Memorial Professional Corp Internal Medicine 1272 W Main St, Bldg 2 Ste 3, Newark, OH 43055-2004 2010-09-27
1134430887 Read's Pharmacy LLC Pharmacy 1272 W Main St, Newark, OH 43055-2004 2010-06-28
1396905584 Christopher Matthew Forbush Family Medicine 1272 W Main St, Suite 503, Newark, OH 43055 2008-06-11
1932389335 Newark Orthopaedics,inc. Orthopaedic Surgery 1272 W Main St, Building 2, Newark, OH 43055-2004 2007-11-14
1831381706 Licking Memorial Professional Corporation Surgery 1272 W Main St, Bldg. 2, Newark, OH 43055-2004 2007-08-15
1871654681 Paul Norman Montalto Family Medicine 1272 W Main St, Suite 2, Newark, OH 43055-2004 2006-12-13
1063580199 Catherine Chiodo Podiatrist 1272 W Main St, Building #4, Newark, OH 43055-2004 2006-11-30
1063518926 Michael Bradshaw Vitt Dentist 1272 W Main St, Bldg 3, Newark, OH 43055-2004 2006-09-16
1336169770 Licking Memorial Professional Corporation Family Medicine 1272 W Main St, Bldg. 1, Newark, OH 43055-2004 2006-07-20
Find all providers in the same location

Providers in the same zip code

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 Information

Taxonomy Code 208600000X
Grouping Allopathic & Osteopathic Physicians
Classification Surgery

Taxonomy Definition

A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]
- Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1538663869 Niravkumar M Chauhan Surgery 185 S Orange Ave # Msbf508b, Newark, NJ 07103-2757 2018-03-21
1821449604 Joseph Galloway Surgery 140 Bergen Street Acc-d1610, Newark, NJ 07103 2016-06-23
1962844621 John Daniel Robb Surgery 4755 Ogletown Stanton Road Ste 1e50, Ctr for Heart & Vascular Health Christiana Hospital, Newark, DE 19718-2200 2013-07-23
1992083521 Ioannis Loumiotis Surgery 201 Lyons Ave Ste G5, Newark, NJ 07112-2027 2011-08-01
1336434257 Nicole Goulet Surgery 185 S Orange Ave # Msbg514, Newark, NJ 07103-2757 2011-06-20
1366679946 Adriana I Suarez-ligon Surgery 205 South Orange Avenue, F 1214, Newark, NJ 07103 2009-06-22
1285809475 Jason Evan Davis Surgery 150 Bergen Avenue, Uh Division of Vascular Surgery, Newark, NJ 07103 2008-04-28
1306068788 Melissa Marie Alvarez-downing Surgery 90 Bergen St Fl 7, Newark, NJ 07103-2425 2007-05-03
1447305107 Nikolay Mindadze Surgery 4735 Ogletown Stanton Road, Suite 3301, Medical Arts Pavillion 2, Newark, DE 19713-2067 2007-01-24
1639245350 Howard Reeves Surgery 131 Mcmillen Drive, Newark, OH 43055 2006-11-27
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Competitor

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City NEWARK
Zip Code 43055

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Dataset Information

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.

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