NPIMap

Organization Active NPI

Licking Memorial Professional Corp.

Doing business as Licking Memorial Pulmonology

  • Pulmonary Disease Physician
  • Newark, OH
National Provider Identifier
1326068768
Registry record updated Nov 12, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
Legal business name
LICKING MEMORIAL PROFESSIONAL CORP.
Doing business as
Licking Memorial Pulmonology
Practice address
1320 West Main Street
Newark, OH 43055-1822
Phone
(740) 348-1805
Fax
(740) 348-1806
NPI assigned
Jul 20, 2006
Last updated
Nov 12, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2010

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

Authorized official

Name
Cynthia L. Webster
Title
VP Financial Services
Phone
(740) 348-4027

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X Primary

Addresses

Primary practice location

1320 West Main Street
Newark, OH 43055-1822

Mailing address

1320 West Main Street
Newark, OH 43055-1822
Phone (740) 348-1805

Other names 1

  • Licking Memorial Pulmonology 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

NPI Registry JSON

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289520000000",
    "number": "1326068768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1320 WEST MAIN STREET",
            "city": "NEWARK",
            "state": "OH",
            "postal_code": "430551822",
            "telephone_number": "740-348-1805",
            "fax_number": "740-348-1806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1320 WEST MAIN STREET",
            "city": "NEWARK",
            "state": "OH",
            "postal_code": "430551822",
            "telephone_number": "740-348-1805",
            "fax_number": "740-348-1806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LICKING MEMORIAL PROFESSIONAL CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-20",
        "last_updated": "2010-11-12",
        "status": "A",
        "authorized_official_last_name": "WEBSTER",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "VP FINANCIAL SERVICES",
        "authorized_official_telephone_number": "740-348-4027"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Licking Memorial Pulmonology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Newark, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2010; 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.