LICKING MEMORIAL PROFESSIONAL CORPORATION (NPI# 1831381706) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831381706 |
| Entity Type | Organization |
| Organization Name | LICKING MEMORIAL PROFESSIONAL CORPORATION |
| Other Organization Name | LICKING MEMORIAL RECONSTRUCTIVE & COSMETIC SERVICES |
| Practice Address |
1272 W Main St Bldg. 2 Newark OH 43055-2004 |
| Practice Telephone | 7403487955 |
| Practice Fax Number | 7403487956 |
| Mailing Telephone | 7403487955 |
| Mailing Fax Number | 7403487956 |
| Enumeration Date | 2007-08-15 |
| Last Update Date | 2007-08-15 |
| Authorized Official Name | RENEE SPRING-IVES (CREDENTIALING COORDINATOR) |
| Authorized Official Telephone | 7403484027 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0122X |
Surgery Specialization: Plastic and Reconstructive Surgery |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Licking Memorial Reconstructive & Cosmetic Services | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053758631 | Licking Memorial Professional Corporation | Obstetrics & Gynecology | 270 Goosepond Road, Ste 102, Newark, OH 43055 | 2013-05-23 |
| 1740623628 | Licking Memorial Professional Corporation | Internal Medicine | 1272 West Main Street Bldg 2, Ste 4, Newark, OH 43055 | 2013-04-10 |
| 1457625758 | Licking Memorial Professional Corporation | Dermatology | 1272 West Main Street Bldg 2 Ste. 2, Newark, OH 43055 | 2012-03-05 |
| 1093955932 | Licking Memorial Professional Corporation | Surgery | 1 Healthy Pl Ste 202, Pataskala, OH 43062-7067 | 2009-03-05 |
| 1083646442 | Licking Memorial Professional Corporation | Otolaryngology | 88 Mcmillen Dr, Newark, OH 43055-5814 | 2006-07-07 |
| 1326436510 | Licking Memorial Professional Corporation | Durable Medical Equipment & Medical Supplies | 1717 W Main St, Suite 201, Newark, OH 43055-1347 | 2014-12-23 |
| 1700291416 | Licking Memorial Professional Corporation | Dermatology | 1 Healthy Pl, Suite 205, Pataskala, OH 43062-7067 | 2014-06-23 |
| 1962684084 | Licking Memorial Professional Corporation | Family Medicine | 75 Mcmillen Dr, Newark, OH 43055-1808 | 2007-11-30 |
| 1952581274 | Licking Memorial Professional Corporation | Family Medicine | 151 Price Rd, Newark, OH 43055-3317 | 2007-11-05 |
| 1578755435 | Licking Memorial Professional Corporation | Psychiatry & Neurology | 1272 West Main Street, Bldg 2, Newark, OH 43055-2004 | 2007-08-15 |
| Street Address |
1272 W MAIN ST BLDG. 2 |
| City | NEWARK |
| State | OH |
| Zip Code | 43055-2004 |
| 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 |
| 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 |
| 1366461386 | Licking Memorial Professional Corp. | Surgery | 1272 W Main St, Bldg. 3, Newark, OH 43055-2004 | 2006-07-19 |
| Find all providers in the same location | ||||
| 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 |
| Find all providers in zip 43055 | ||||
| Taxonomy Code | 2086S0122X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Plastic and Reconstructive Surgery |
| A surgeon who specializes in plastic and reconstructive surgery. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A General Certificate is issued by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093044091 | Jonathan N Saunders Md Pa | Surgery | E62 Omega Professional Center, Newark, DE 19713-2061 | 2009-12-22 |
| 1578731857 | Julia W Macrae Md Pa | Surgery | E-62 Omega Dr, Newark, DE 19713-2061 | 2008-02-20 |
| 1912123894 | Christiana Cosmetic Surgery Consultants LLC | Surgery | E 62 Omega Professional Center, Newark, DE 19713 | 2007-04-18 |
| 1902988256 | Julia W Macrae | Surgery | E62 Omega Dr, Omega Professional Center, Newark, DE 19713 | 2006-10-19 |
| 1235252669 | John L Roussalis | Surgery | 537 Stanton Christiana Rd, Newark, DE 19713-2146 | 2007-04-09 |
| 1952466518 | Ramazi Otarovich Datiashvili | Surgery | 90 Bergen St, Doc 7200, Newark, NJ 07103-2425 | 2006-12-26 |
| 1699835744 | Earl J. Fleegler | Surgery | 90 Bergen St, Doc 7200, Newark, NJ 07103-2425 | 2006-12-11 |
| 1699746875 | Frank Ciminello | Surgery | 90 Bergen St, Doc 7200, Newark, NJ 07103-2425 | 2006-01-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770192304 | Roberta S Mckinley | Surgery | 5955 Carrbridge Ct, Galloway, OH 43119-1105 | 2020-07-29 |
| 1841707346 | Ptek Solutions | Surgery | 355 E Campus View Blvd Ste 290, Columbus, OH 43235-5680 | 2018-01-05 |
| 1336660034 | Andrew O'brien | Surgery | 915 Olentangy River Rd Fl 2, Columbus, OH 43212-3153 | 2017-07-03 |
| 1114248044 | Advanced Aesthetics and Rejuvination Inc | Surgery | 30701 Lorain Rd Ste A, North Olmsted, OH 44070-6325 | 2010-06-15 |
| 1700118114 | Vidas Dumasius | Surgery | 400 Matthew St Ste B-1, Marietta, OH 45750-1644 | 2010-02-10 |
| 1033382411 | Derek Cody | Surgery | 3925 Embassy Parkway, Suite 300, Akron, OH 44333 | 2008-04-08 |
| 1043381189 | Steven A Goldman Md Inc | Surgery | 3609 Park East Dr Ste 206, Beachwood, OH 44122-4309 | 2006-11-12 |
| 1922198357 | Michael P Binder | Surgery | 8587 East Ave, Mentor, OH 44060-4301 | 2006-10-14 |
| 1154416857 | Jason E Leedy | Surgery | 2060 Lander Rd, Mayfield Heights, OH 44124-4100 | 2006-10-04 |
| 1841225356 | Steven Scott Carp | Surgery | 4031 Massillon Road, Ste A, Uniontown, OH 44685 | 2006-07-12 |
| Find all providers with the same taxonomy | ||||
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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.