NPIMap

Organization Active NPI

Licking Memorial Professional Corp

  • Family Medicine Physician
  • Newark, OH
National Provider Identifier
1831381797
Registry record updated Oct 12, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
LICKING MEMORIAL PROFESSIONAL CORP
Practice address
270 Goosepond Rd
Newark, OH 43055-3104
Phone
(740) 348-7960
Fax
(740) 348-7961
NPI assigned
Aug 15, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2011

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

Authorized official

Name
Cynthia L. Webster
Title
VP of Financial Services
Phone
(740) 348-4819

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

270 Goosepond Rd
Newark, OH 43055-3104

Mailing address

270 Goosepond Rd
Newark, OH 43055-3104
Phone (740) 348-7960

Other names 1

  • LICKING MEMORIAL FAMILY PRACTICE NORTH NEWARK 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

270 Goosepond Rd
Newark, OH 43055
Phone (220) 564-7960

NPI Registry JSON

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

{
    "created_epoch": "1187136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318377600000",
    "number": "1831381797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "270 GOOSEPOND RD",
            "city": "NEWARK",
            "state": "OH",
            "postal_code": "430553104",
            "telephone_number": "740-348-7960",
            "fax_number": "740-348-7961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "270 GOOSEPOND RD",
            "city": "NEWARK",
            "state": "OH",
            "postal_code": "430553104",
            "telephone_number": "740-348-7960",
            "fax_number": "740-348-7961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LICKING MEMORIAL PROFESSIONAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-15",
        "last_updated": "2011-10-12",
        "status": "A",
        "authorized_official_last_name": "WEBSTER",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "VP OF FINANCIAL SERVICES",
        "authorized_official_telephone_number": "740-348-4819"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LICKING MEMORIAL FAMILY PRACTICE NORTH NEWARK",
            "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 Oct 12, 2011; 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.