NPIMap

Organization Active NPI

Licking Memorial Professional Corp.

Doing business as Licking Memorial Surgical Services

  • Surgery Physician
  • Newark, OH
National Provider Identifier
1366461386
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
LICKING MEMORIAL PROFESSIONAL CORP.
Doing business as
Licking Memorial Surgical Services
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
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Robert A. Montagnese
Title
Executive V.P.
Phone
(740) 348-4000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X Primary

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 names 1

  • Licking Memorial Surgical Services 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

Locations

96 Integrity Dr
Hebron, OH 43025
Phone (220) 564-7930

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

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

1272 W Main St
Ste 302
Newark, OH 43055
Phone (220) 564-1880

1272 W Main St
Ste 503
Newark, OH 43055
Phone (220) 564-1778

150 McMillen Dr
Ste 100
Newark, OH 43055
Phone (220) 564-1765

1717 W Main St
Newark, OH 43055

1717 W Main St
Apt 202
Newark, OH 43055
Phone (220) 564-7970

1717 W Main St
Ste 2023
Newark, OH 43055

1865 Tamarack Rd
Newark, OH 43055
Phone (220) 564-4972

1865 Tamarack Rd
Ste G
Newark, OH 43055

20 W Locust St
Newark, OH 43055
Phone (220) 564-4835

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

1 Healthy Pl
Ste 102
Pataskala, OH 43062
Phone (220) 564-1915

1 Healthy Pl
Ste 201
Pataskala, OH 43062
Phone (220) 564-1920

455 School St
Ste 29
Tomball, TX 77375
Phone (281) 351-1195

Practitioners & affiliated clinicians

Practitioners 108

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 108

NPI Registry JSON

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1366461386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1272 W MAIN ST",
            "address_2": "BLDG. 3",
            "city": "NEWARK",
            "state": "OH",
            "postal_code": "430552004",
            "telephone_number": "740-348-1880",
            "fax_number": "740-348-1881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1272 W MAIN ST",
            "address_2": "BLDG. 3",
            "city": "NEWARK",
            "state": "OH",
            "postal_code": "430552004",
            "telephone_number": "740-348-1880",
            "fax_number": "740-348-1881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LICKING MEMORIAL PROFESSIONAL CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MONTAGNESE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "EXECUTIVE V.P.",
        "authorized_official_telephone_number": "740-348-4000"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Licking Memorial Surgical Services",
            "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 Aug 22, 2020; 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.