LICKING MEMORIAL PROFESSIONAL CORP. (NPI# 1891715223) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891715223 |
| Entity Type | Organization |
| Organization Name | LICKING MEMORIAL PROFESSIONAL CORP. |
| Other Organization Name | LICKING MEMORIAL OCCUPATIONAL MEDICINE |
| Practice Address |
1865 Tamarack Rd Newark OH 43055-2305 |
| Practice Telephone | 7403484972 |
| Practice Fax Number | 7403484991 |
| Mailing Telephone | 7403484972 |
| Mailing Fax Number | 7403484991 |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | ROBERT A. MONTAGENSE (EXECUTIVE V.P.) |
| Authorized Official Telephone | 7403484000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2083P0500X |
Preventive Medicine Specialization: Preventive Medicine/Occupational Environmental Medicine |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | 2354134 | 05 |
| Other Name | Type Code |
|---|---|
| Licking Memorial Occupational Medicine | 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 |
| 1326068768 | Licking Memorial Professional Corp. | Internal Medicine | 1320 West Main Street, Newark, OH 43055-1822 | 2006-07-20 |
| Street Address |
1865 TAMARACK RD |
| City | NEWARK |
| State | OH |
| Zip Code | 43055-2305 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467450668 | Richard Baltisberger | Pediatrics | 1865 Tamarack Rd, Newark, OH 43055-1350 | 2005-07-12 |
| 1710516281 | Annmarie Thacker | Dietitian, Registered | 1865 Tamarack Rd, Newark, OH 43055-2305 | 2020-04-06 |
| 1659721579 | Teressa Blanchard | Nurse Practitioner | 1865 Tamarack Rd, Newark, OH 43055 | 2016-06-22 |
| 1104146711 | Catherine R Wohlford | Nurse Practitioner | 1865 Tamarack Rd, Newark, OH 43055-2305 | 2010-06-04 |
| 1083634414 | Licking Memorial Professional Corp | Pediatrics | 1865 Tamarack Rd, Newark, OH 43055-2305 | 2006-07-20 |
| 1174549604 | Kelly Morrison | Nurse Practitioner | 1865 Tamarack Rd, Newark, OH 43055-2305 | 2006-07-15 |
| 1366411621 | Susan C Zwiebel | Emergency Medicine | 1865 Tamarack Rd, Newark, OH 43055 | 2006-03-17 |
| 1154300887 | Timothy Robert Gatens | Physical Medicine & Rehabilitation | 1865 Tamarack Rd, Newark, OH 43055-1350 | 2006-01-11 |
| 1801895990 | Shelley Gittens | Pediatrics | 1865 Tamarack Rd, Newark, OH 43055 | 2005-07-20 |
| 1447259270 | Charles Marty | Preventive Medicine | 1865 Tamarack Rd, Newark, OH 43055-1350 | 2005-07-14 |
| 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 | 2083P0500X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Preventive Medicine |
| Specialization | Preventive Medicine/Occupational Environmental Medicine |
| A preventive medicine physician who specializes in preventive medicine/occupational-environmental medicine, which is focused on protecting the population from occupational and environmental conditions. |
| 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 Preventive Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780295386 | Healthstat Inc Huhtamaki New Vienna | Preventive Medicine | 5566 New Vienna Rd, New Vienna, OH 45159-9533 | 2020-08-17 |
| 1679101125 | Healthstat Onsite Clinic Vertiv Ironton | Preventive Medicine | 3040 S 9th St, Ironton, OH 45638-2895 | 2020-03-31 |
| 1760010219 | Healthstat Onsite Clinic Vertiv Dearborne | Preventive Medicine | 1050 Dearborn Dr, Columbus, OH 43085-1544 | 2020-03-31 |
| 1033747589 | Healthstat Onsite Clinic Vertiv Delaware | Preventive Medicine | 975 Pittsburgh Dr, Delaware, OH 43015-2858 | 2020-03-31 |
| 1538716790 | Healthstat Onsite Clinic Goodyear Icm | Preventive Medicine | 1367 Techway Drive, Akron, OH 44316 | 2019-08-22 |
| 1336796911 | Healthstat Onsite Clinic Goodyear Akron | Preventive Medicine | 200 E Innovation Way Ste 300, Akron, OH 44316-0001 | 2019-08-20 |
| 1477058576 | Healthstat Onsite Affinion Group | Preventive Medicine | 300 W Schrock Rd, Westerville, OH 43081-1189 | 2018-03-29 |
| 1568979045 | Healthstat Onsiet Clinic Nk Parts | Preventive Medicine | 800 S Kuther Rd, Sidney, OH 45365 | 2018-01-05 |
| 1346693876 | Healthstat Onsite Clinic Amsted Gw Groveport | Preventive Medicine | 3900 Bixby Rd, Groveport, OH 43125-9510 | 2016-07-20 |
| 1427309137 | Leslie M. Yee | Preventive Medicine | 4139 Malaer Dr, Cincinnati, OH 45241-6623 | 2012-09-21 |
| 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.