NPIMap

Organization Active NPI

Licking Memorial Professional Corporation

  • Surgery Physician
  • Pataskala, OH
National Provider Identifier
1093955932
Registry record updated Mar 6, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
34008308 Issued in OH
Legal business name
LICKING MEMORIAL PROFESSIONAL CORPORATION
Doing business as
Licking Memorial Pataskala Specialties
Practice address
1 Healthy PL Ste 202
Pataskala, OH 43062-7067
Phone
(740) 348-1935
Fax
(740) 348-1936
NPI assigned
Mar 5, 2009
Organization subpart
Yes
Parent organization
LICKING MEMORIAL PROFESSIONAL CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 6, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Cynthia Webster
Title
VP Revenue Cycle & Interim VP Finan
Phone
(740) 348-4027

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X 34008308 OH Primary

Addresses

Primary practice location

1 Healthy PL Ste 202
Pataskala, OH 43062-7067

Mailing address

1 Healthy PL Ste 202
Pataskala, OH 43062-7067
Phone (740) 348-1935

Other names 1

  • Licking Memorial Pataskala Specialties Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031203000131 OH Part B Supplier - Clinic/Group Practice 6204740731 Receives reassigned benefits from 282 practitioners
45 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Newark, OH; Pataskala, OH; Utica, OH; Heath, OH; Hebron, OH; Johnstown, OH; Granville, OH

Other NPIs on the same Medicare enrollment 45

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 45

National Provider Directory

National Provider Directory
Part of
Licking Memorial Profes

Locations

1 Healthy Pl
Ste 202
Pataskala, OH 43062
Phone (220) 564-1965

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1236211200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236297600000",
    "number": "1093955932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 HEALTHY PL STE 202",
            "city": "PATASKALA",
            "state": "OH",
            "postal_code": "430627067",
            "telephone_number": "740-348-1935",
            "fax_number": "740-348-1936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 HEALTHY PL STE 202",
            "city": "PATASKALA",
            "state": "OH",
            "postal_code": "430627067",
            "telephone_number": "740-348-1935",
            "fax_number": "740-348-1936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LICKING MEMORIAL PROFESSIONAL CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LICKING MEMORIAL PROFESSIONAL CORPORATION",
        "enumeration_date": "2009-03-05",
        "last_updated": "2009-03-06",
        "status": "A",
        "authorized_official_last_name": "WEBSTER",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_title_or_position": "VP REVENUE CYCLE & INTERIM VP FINAN",
        "authorized_official_telephone_number": "740-348-4027"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "OH",
            "license": "34008308",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Licking Memorial Pataskala Specialties",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pataskala, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.