LICKING MEMORIAL PROFESSIONAL CORPORATION (NPI# 1053758631) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053758631 |
| Entity Type | Organization |
| Organization Name | LICKING MEMORIAL PROFESSIONAL CORPORATION |
| Other Organization Name | LICKING MEMORIAL WOMEN'S HEALTH- NORTH NEWARK |
| Practice Address |
270 Goosepond Road Ste 102 Newark OH 43055 |
| Mailing Address |
270 Goosepond Rd. Ste 102 Newark OH 43055 |
| Practice Telephone | 7403487945 |
| Practice Fax Number | 7403487946 |
| Mailing Telephone | 7403487945 |
| Mailing Fax Number | 7403487946 |
| Enumeration Date | 2013-05-23 |
| Last Update Date | 2013-05-23 |
| Authorized Official Name | CYNTHIA L. WEBSTER (VP FINANCIAL SERVICE) |
| Authorized Official Telephone | 7403484518 |
| Is Organization Subpart | Y |
| Parent Organization Name | LICKING MEMORIAL PROFESSIONAL CORPORATION |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207VG0400X |
Obstetrics & Gynecology Specialization: Gynecology |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Licking Memorial Women's Health- North Newark | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740623628 | Licking Memorial Professional Corporation | Internal Medicine | 1272 West Main Street Bldg 2, Ste 4, Newark, OH 43055 | 2013-04-10 |
| 1457625758 | Licking Memorial Professional Corporation | Dermatology | 1272 West Main Street Bldg 2 Ste. 2, Newark, OH 43055 | 2012-03-05 |
| 1093955932 | Licking Memorial Professional Corporation | Surgery | 1 Healthy Pl Ste 202, Pataskala, OH 43062-7067 | 2009-03-05 |
| 1083646442 | Licking Memorial Professional Corporation | Otolaryngology | 88 Mcmillen Dr, Newark, OH 43055-5814 | 2006-07-07 |
| 1326436510 | Licking Memorial Professional Corporation | Durable Medical Equipment & Medical Supplies | 1717 W Main St, Suite 201, Newark, OH 43055-1347 | 2014-12-23 |
| 1700291416 | Licking Memorial Professional Corporation | Dermatology | 1 Healthy Pl, Suite 205, Pataskala, OH 43062-7067 | 2014-06-23 |
| 1962684084 | Licking Memorial Professional Corporation | Family Medicine | 75 Mcmillen Dr, Newark, OH 43055-1808 | 2007-11-30 |
| 1952581274 | Licking Memorial Professional Corporation | Family Medicine | 151 Price Rd, Newark, OH 43055-3317 | 2007-11-05 |
| 1578755435 | Licking Memorial Professional Corporation | Psychiatry & Neurology | 1272 West Main Street, Bldg 2, Newark, OH 43055-2004 | 2007-08-15 |
| 1740472604 | Licking Memorial Professional Corporation | Dermatology | 270 Goosepond Rd, Newark, OH 43055-3104 | 2007-08-15 |
| Street Address |
270 GOOSEPOND ROAD STE 102 |
| City | NEWARK |
| State | OH |
| Zip Code | 43055 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770125585 | Jessica Danielle Dunkle | Case Manager/Care Coordinator | 15 N 3rd Street Suite 300, Newark, OH 43055 | 2019-10-14 |
| 1558910331 | Diana Cleland | Home Health Aide | 25 Western Rd, Apartment A, Newark, OH 43055 | 2019-09-05 |
| 1912424789 | Sandra Lou Fraley | Community/Behavioral Health | 15 North 3rd Street, Suite 300, Newark, OH 43055 | 2017-08-23 |
| 1215450911 | Caitlyn Thella Smith Elkins | Social Worker | 15 N. 3rd St., Newark, OH 43055 | 2017-07-25 |
| 1992227888 | Sierra Elizabeth Donley | Student in an Organized Health Care Education/Training Program | 140 W Church St, Newark, OH 43055 | 2017-07-12 |
| 1386170587 | Patricia Louise Fischer | Pharmacist | 1155 North 21rst Street, Newark, OH 43055 | 2017-05-08 |
| 1689120958 | Bebout Services, LLC | Home Health | 1325 Dayton Road Ne, Newark, OH 43055 | 2016-08-28 |
| 1750834594 | Laura Smith | Registered Nurse | 1445 West Main Street, Suite B, Newark, OH 43055 | 2016-07-28 |
| 1164807277 | Frank Kobe | Psychologist | 116 N. 21st Street, Newark, OH 43055 | 2015-07-30 |
| 1770975898 | Gentle Foot Care, Inc | Podiatrist | 1271 W Main Street, Bldg 1, Newark, OH 43055 | 2015-02-26 |
| Find all providers in zip 43055 | ||||
| Taxonomy Code | 207VG0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| Specialization | Gynecology |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861535544 | Ronaldo L Domingo | Obstetrics & Gynecology | 620 Christiana Med Ctr, Newark, DE 19702 | 2007-02-14 |
| 1366552671 | Linda Hipps | Obstetrics & Gynecology | 140 Bergen St # C, Newark, NJ 07103 | 2006-08-30 |
| 1538184791 | Matthew J Fagan | Obstetrics & Gynecology | 4375 Ogletown Stanton Road, Suite 1208, Newark, DE 19713-2089 | 2006-07-12 |
| 1366960734 | Womens Healthcare Consultants Inc | Obstetrics & Gynecology | 1400 Peoples Plz Ste 301, Newark, DE 19702-5708 | 2017-09-06 |
| 1114208725 | David Kulak | Obstetrics & Gynecology | 185 S Orange Ave, E-561, Newark, NJ 07103-2757 | 2011-09-09 |
| 1457682213 | Nia Medical Center and Spa, LLC | Obstetrics & Gynecology | 851 Mount Prospect Ave, Newark, NJ 07104-3228 | 2010-01-19 |
| 1356421812 | Mark H Einstein | Obstetrics & Gynecology | 185 S Orange Ave, Rutgers New Jersey Medical School, Msb E-506, Newark, NJ 07103-2757 | 2006-10-17 |
| 1457452393 | Estelle H Whitney | Obstetrics & Gynecology | 4735 Ogletown Stanton Rd, Map 2, Suite 2103, Newark, DE 19713-2072 | 2006-09-25 |
| 1588680136 | Delaware Gynecology | Obstetrics & Gynecology | 2707 Kirkwood Hwy, Newark, DE 19711-6828 | 2006-07-15 |
| 1942275078 | Claude Macajoux | Obstetrics & Gynecology | 151 Washington St, Newark, NJ 07102-3026 | 2006-02-22 |
| Find all providers in NEWARK | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.