LICKING MEMORIAL HOSPITAL (NPI# 1568446755) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568446755 |
| Entity Type | Organization |
| Organization Name | LICKING MEMORIAL HOSPITAL |
| Practice Address |
1320 W Main St Newark OH 43055-1822 |
| Practice Telephone | 7403484513 |
| Practice Fax Number | 7403484517 |
| Mailing Telephone | 7403484513 |
| Mailing Fax Number | 7403484517 |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. ROBERT A MONTAGNESE (EXECUTIVE VICE PRESIDENT) |
| Authorized Official Telephone | 7403484526 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 282N00000X | General Acute Care Hospital | Hospitals |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | 5172389 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720163637 | Licking Memorial Hospital | Home Health | 1865 Tamarack Rd Ste B, Newark, OH 43055-2316 | 2006-10-26 |
| 1912258898 | Licking Memorial Hospital | Rehabilitation Unit | 1320 W Main St, Newark, OH 43055-1822 | 2012-10-02 |
| Street Address |
1320 W MAIN ST |
| City | NEWARK |
| State | OH |
| Zip Code | 43055-1822 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629076898 | Jeff Bare | Emergency Medicine | 1320 W Main St, Newark, OH 43055-1822 | 2005-07-12 |
| 1538767116 | Amanda Kay Codlin | Nurse Practitioner | 1320 W Main St, Newark, OH 43055-1822 | 2020-10-15 |
| 1053928101 | Andrea Sims | Nurse Practitioner | 1320 W Main St, Newark, OH 43055-1822 | 2020-09-23 |
| 1376155630 | Jeanette Carpenter | Nurse Practitioner | 1320 W Main St, Newark, OH 43055-1822 | 2020-08-18 |
| 1912521451 | Courtney Marie Adams | Nurse Anesthetist, Certified Registered | 1320 W Main St, Newark, OH 43055-1822 | 2020-06-01 |
| 1770105603 | Jason Sturgeon | Clinic/Center | 1320 W Main St, Newark, OH 43055-1822 | 2020-05-14 |
| 1376195248 | Rahel Gebeyehu Mitiku | Nurse Practitioner | 1320 W Main St, Newark, OH 43055-1822 | 2019-07-11 |
| 1720544232 | Corey Salyer | Nurse Practitioner | 1320 W Main St, Newark, OH 43055-1822 | 2019-02-20 |
| 1851860589 | Tabitha Gartner | Nurse Practitioner | 1320 W Main St, Newark, OH 43055-1822 | 2018-11-26 |
| 1972010783 | Patricia Joan Liesen | Dietitian, Registered | 1320 W Main St, Newark, OH 43055-1822 | 2018-01-02 |
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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 | 282N00000X |
| Grouping | Hospitals |
| Classification | General Acute Care Hospital |
| An acute general hospital is an institution whose primary function is to provide inpatient diagnostic and therapeutic services for a variety of medical conditions, both surgical and non-surgical, to a wide population group. The hospital treats patients in an acute phase of illness or injury, characterized by a single episode or a fairly short duration, from which the patient returns to his or her normal or previous level of activity. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538605795 | Christiana Care Health System | General Acute Care Hospital | Christiana Care Heart & Vascular Health, 4755 Ogletown-stanton Road, Newark, DE 19718-0001 | 2017-01-12 |
| 1295026334 | University of Medicine and Dentistry of New Jersey | General Acute Care Hospital | 62 Marrow St, Newark, NJ 07103-3131 | 2011-04-24 |
| 1336456201 | Christiana Care Health Services | General Acute Care Hospital | 4755 Stanton Ogletown Rd, Newark, DE 19718-0001 | 2010-09-13 |
| 1912173667 | Christiana Care Health Services | General Acute Care Hospital | 4745 Ogletown Stanton Rd Ste 128, Newark, DE 19713-2082 | 2008-05-02 |
| 1487863668 | Center for Childhood and Neonatal Surgery | General Acute Care Hospital | 90 Bergen St. Suite 7100, Newark, NJ 07103 | 2007-05-22 |
| 1306053483 | University Hospital | General Acute Care Hospital | 150 Bergen St # D106, Newark, NJ 07103-2496 | 2007-05-17 |
| 1578694626 | Christianacarehealthservices | General Acute Care Hospital | 30 Garvey Ln, Newark, DE 19702-6302 | 2007-03-08 |
| 1487790663 | University Psychiatric Associates | General Acute Care Hospital | Upa, 183 South Orange Ave, Newark, NJ 07103 | 2007-01-29 |
| 1083192298 | Christiana Care Health System | General Acute Care Hospital | 4755 Ogletown Stanton Rd Ste 5a43, Newark, DE 19718-2200 | 2018-07-31 |
| 1487181228 | Newark Beth Israel Medical Center | General Acute Care Hospital | 201 Lyons Ave, Department of Emergency Medicine, Newark, NJ 07112-2027 | 2017-05-11 |
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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.