NPIMap

Organization Active NPI

Licking Memorial Professional Corporation

Doing business as Licking Memorial Orthopedic DME

  • Durable Medical Equipment & Medical Supplies
  • Newark, OH
National Provider Identifier
1326436510
Registry record updated Sep 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
LICKING MEMORIAL PROFESSIONAL CORPORATION
Doing business as
Licking Memorial Orthopedic DME
Practice address
1717 W Main St
Suite 201
Newark, OH 43055-1347
Phone
(220) 564-2900
Fax
(220) 564-2901
NPI assigned
Dec 23, 2014
Last updated
Sep 12, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
LICKING MEMORIAL PROFESSIONAL CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 12, 2016

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
(220) 564-4000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

1717 W Main St
Suite 201
Newark, OH 43055-1347

Mailing address

1717 W Main St
Suite 201
Newark, OH 43055-1347
Phone (220) 564-2900

Other names 1

  • Licking Memorial Orthopedic DME Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH2 enrollments

Enrollment records 2

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
O20150819009534 OH DME Supplier - Physician - Orthopedic/Orthopedic Surgery 6204740731 Practice locations: Newark, OH

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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 Mem Prof Corp

Locations

687 Hopewell Dr
#2
Heath, OH 43056
Phone (740) 348-7915

96 Integrity Dr
Ste H
Hebron, OH 43025
Phone (220) 564-2100

151 Woodgate Dr
Johnstown, OH 43031
Phone (220) 564-1810

120 McMillen Dr
Ste N4
Newark, OH 43055
Phone (740) 348-7950

1272 W Main St
Ste 100
Newark, OH 43055
Phone (220) 564-1702

1272 W Main St
Ste 203
Newark, OH 43055
Phone (220) 564-1760

1272 W Main St
Ste 204
Newark, OH 43055
Phone (220) 564-1740

1272 W Main St
Ste 401
Newark, OH 43055
Phone (220) 564-1750

1717 W Main St
Apt 201
Newark, OH 43055
Phone (220) 564-2900

1717 W Main St
Apt 204
Newark, OH 43055
Phone (220) 564-7955

1902 Tamarack Rd
Newark, OH 43055
Phone (220) 564-7975

1906 Tamarack Rd
Newark, OH 43055
Phone (220) 564-7780

270 Goosepond Rd
#102
Newark, OH 43055
Phone (740) 348-7945

270 Goosepond Rd
Ste 102
Newark, OH 43055
Phone (220) 564-7945

66 McMillen Dr
Newark, OH 43055
Phone (614) 348-4949

1 Healthy Pl
#101
Pataskala, OH 43062
Phone (740) 348-1900

1 Healthy Pl
#201
Pataskala, OH 43062
Phone (740) 348-1920

1 Healthy Pl
#205
Pataskala, OH 43062
Phone (740) 348-1930

1 Healthy Pl
Ste 101
Pataskala, OH 43062
Phone (220) 564-1900

Practitioners & affiliated clinicians

Practitioners 302

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 302

NPI Registry JSON

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

{
    "created_epoch": "1419292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473638400000",
    "number": "1326436510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1717 W MAIN ST",
            "address_2": "SUITE 201",
            "city": "NEWARK",
            "state": "OH",
            "postal_code": "430551347",
            "telephone_number": "220-564-2900",
            "fax_number": "220-564-2901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 W MAIN ST",
            "address_2": "SUITE 201",
            "city": "NEWARK",
            "state": "OH",
            "postal_code": "430551347",
            "telephone_number": "220-564-2900",
            "fax_number": "220-564-2901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LICKING MEMORIAL PROFESSIONAL CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LICKING MEMORIAL PROFESSIONAL CORPORATION",
        "enumeration_date": "2014-12-23",
        "last_updated": "2016-09-12",
        "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": "220-564-4000"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Licking Memorial Orthopedic DME",
            "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 Sep 12, 2016; 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.