Licking Memorial Professional Corp.
Organization Active NPI Surgery Physician · Newark, OH
NPI 1366461386 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1366461386
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Surgery Physician 208600000X
- Legal business name
- LICKING MEMORIAL PROFESSIONAL CORP.
- Practice address
- 1272 W Main St
BLDG. 3
Newark, OH 43055-2004 - Phone
- (740) 348-1880
- Fax
- (740) 348-1881
- NPI assigned
- Jul 19, 2006
- Organization subpart
- No
Authorized official
- Name
- Robert A. Montagnese
- Title
- Executive V.P.
- Phone
- (740) 348-4000
Other NPIs on the same Medicare enrollment 45
Practitioners 108
-
Abhay J. Anand, M.D.
-
Emilia N. Anigbo, M.D.
-
Michael D Barth, MD
-
Zackary Birchard, DO
-
Carrie Lynn Brehm, PA-C
-
Roy Reginald Brown Jr., M.D.
-
Catherine Chiodo, D.P.M.
-
Jacqueline L Cleland, CNM
-
Adam J Clemens, MD
-
Joan Crumrine, CNP
-
Anthony D'Amico, PA
-
Janae M. Davis, M.D.
-
Amanda Leigh Day, APRN
-
Sadie Ann Deckard, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
Locations
96 Integrity Dr
Hebron, OH 43025
Phone (220) 564-7930
96 Integrity Dr
Ste H
Hebron, OH 43025
Phone (220) 564-2100
30 Messimer Dr
Newark, OH 43055
Phone (740) 344-6904
1902 Tamarack Rd
Newark, OH 43055
Phone (220) 564-7975
1970 Tamarack Rd
Newark, OH 43055
Phone (220) 564-1770
14 Westgate Dr
Newark, OH 43055
Phone (220) 564-7500
1980 Tamarack Rd
Newark, OH 43055
Phone (220) 564-7520
1272 W Main St
Ste 206
Newark, OH 43055
Phone (220) 564-4824
1717 W Main St
Apt 202
Newark, OH 43055
Phone (220) 564-7970
1865 Tamarack Rd
Bldg 4
Newark, OH 43055
Phone (220) 564-4915
1865 Tamarack Rd
Ste G
Newark, OH 43055
2000 Tamarack Rd
Newark, OH 43055
Phone (740) 788-6000
1906 Tamarack Rd
Newark, OH 43055
Phone (220) 564-7780
1272 W Main St
Ste 302
Newark, OH 43055
Phone (220) 564-1880
1717 W Main St
Ste 2023
Newark, OH 43055
1272 W Main St
Ste 203
Newark, OH 43055
Phone (220) 564-1760
1 Healthy Pl
Ste 102
Pataskala, OH 43062
Phone (220) 564-1915
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician |
208600000X | Yes |
Addresses
Primary practice location
1272 W Main St
BLDG. 3
Newark, OH 43055-2004
Mailing address
1272 W Main St
BLDG. 3
Newark, OH 43055-2004
Phone (740) 348-1880
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2483610 | Medicaid | OH |
Other names
- Licking Memorial Surgical Services
Other providers in Newark, OH
- Licking Memorial Professional Corp.
- Licking Memorial Professional Corp.
- Licking Memorial Professional Corp.
- Licking Memorial Professional Corp.
- Licking Memorial Professional Corp.
- Licking Memorial Professional Corp.
- Licking Memorial Professional Corp.
- Licking Memorial Professional Corp.
- Licking Memorial Professional Corp.
- Licking Memorial Professional Corporation
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.