LICKING MEMORIAL PROFESSIONAL CORPORATION


Address: 88 Mcmillen Dr, Newark, OH 43055-5814
Phone: 7403484270

LICKING MEMORIAL PROFESSIONAL CORPORATION (NPI# 1083646442) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1083646442
Entity Type Organization
Organization Name LICKING MEMORIAL PROFESSIONAL CORPORATION
Other Organization Name LICKING MEMORIAL OTOLARYNGOLOGY
Practice Address 88 Mcmillen Dr
Newark
OH 43055-5814
Practice Telephone 7403484270
Practice Fax Number 7403484272
Mailing Telephone 7403484270
Mailing Fax Number 7403484272
Enumeration Date 2006-07-07
Last Update Date 2020-08-22
Authorized Official Name MR. ROBERT A. MONTAGENSE (EXECUTIVE VICE PRESIDENT)
Authorized Official Telephone 7403484000
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207Y00000X Otolaryngology Allopathic & Osteopathic Physicians

Other Provider/Organization Names

Other Name Type Code
Licking Memorial Otolaryngology Doing Business As Name - Organization

Other Provider IDs and Locations

NPI Name Taxonomy Address Enumeration
1053758631 Licking Memorial Professional Corporation Obstetrics & Gynecology 270 Goosepond Road, Ste 102, Newark, OH 43055 2013-05-23
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
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

Office Location

Street Address 88 MCMILLEN DR
City NEWARK
State OH
Zip Code 43055-5814

Providers in the same location

NPI Name Taxonomy Address Enumeration
1952437295 Holly M Toole Audiologist 88 Mcmillen Dr, Newark, OH 43055-5814 2007-02-23

Providers in the same zip code

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 Information

Taxonomy Code 207Y00000X
Grouping Allopathic & Osteopathic Physicians
Classification Otolaryngology

Taxonomy Definition

An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source]
- Additional Resources: American Board of Otolaryngology, 2007. http://www.aboto.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1760644280 Chan Woo Park Otolaryngology 90 Bergen Street- Suite 8100, Department of Otolaryngology, Doc Building, Newark, NJ 07103 2008-06-26
1467639864 Jagdeep Singh Hundal Otolaryngology 774 Christiana Rd Ste B4, Newark, DE 19713-4219 2008-01-28
1588745483 Shaun R Roof Otolaryngology 88 Mcmillen Drive, Newark, OH 43055 2006-10-18
1932102134 Joseph I Ramzy Otolaryngology 774 Christiana Rd, Suite 107, Newark, DE 19713-4236 2005-05-23
1699225227 University Physician Associates of New Jersey, Inc Otolaryngology 30 Bergen St, Admc 1205, Newark, NJ 07107-3000 2016-10-06
1497137491 First State Ent Association Inc Otolaryngology 774 Christiana Road, Neuroscience Building Ste B4, Newark, DE 19713-4236 2015-06-25
1649618596 Dylan Francis Roden Otolaryngology 90 Bergen St # 8100, Newark, NJ 07103 2013-06-12
1407113921 Wayne Daniel Hsueh Otolaryngology 90 Bergen St Ste 8100, Newark, NJ 07103-2425 2012-04-20
1033405139 Bradley R Lawson Otolaryngology 36 Mcmillen Dr, Newark, OH 43055 2011-06-27
1861783615 Rachel Kaye Otolaryngology 90 Bergen St Ste 8100, Newark, NJ 07103-2425 2011-04-27
Find all providers in NEWARK

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City NEWARK
Zip Code 43055

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Dataset Information

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.

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