LICKING MEMORIAL PROFESSIONAL CORP. (NPI# 1174541924) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174541924 |
| Entity Type | Organization |
| Organization Name | LICKING MEMORIAL PROFESSIONAL CORP. |
| Other Organization Name | LICKING MEMORIAL WOMEN'S HEALTH |
| Practice Address |
15 Messimer Dr Newark OH 43055-1841 |
| Practice Telephone | 7403484694 |
| Practice Fax Number | 7403481978 |
| Mailing Telephone | 7403484694 |
| Mailing Fax Number | 7403481978 |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | ROBERT A. MONTAGNESE (EXECUTIVE VP) |
| Authorized Official Telephone | 7403484000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207V00000X | Obstetrics & Gynecology | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Licking Memorial Women's Health | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235311358 | Licking Memorial Professional Corp. | Family Medicine | 17 Forry St, Newark, OH 43055-4004 | 2007-11-30 |
| 1497771521 | Licking Memorial Professional Corp. | Pediatrics | 240 N. Main St, Utica, OH 43080 | 2006-07-14 |
| 1689690661 | Licking Memorial Professional Corp. | Family Medicine | 96 Integrity Drive, H., Hebron, OH 43025 | 2006-07-14 |
| 1487688545 | Licking Memorial Professional Corp. | Family Medicine | 687 Hopewell Dr, Suite2, Heath, OH 43056-1579 | 2006-07-11 |
| 1598945818 | Licking Memorial Professional Corp. | Family Medicine | 717 S 30th St, Newark, OH 43056-1244 | 2007-11-05 |
| 1669547824 | Licking Memorial Professional Corp. | Pediatrics | 399 E Main St, Newark, OH 43055-6516 | 2006-11-22 |
| 1154496503 | Licking Memorial Professional Corp. | General Practice | 2000 Tamarack Rd, Newark, OH 43055 | 2006-11-21 |
| 1295809614 | Licking Memorial Professional Corp. | Psychiatry & Neurology | 1 Healthy Pl, Suite 105, Pataskala, OH 43062-7067 | 2006-11-17 |
| 1649290073 | Licking Memorial Professional Corp. | Internal Medicine | 120 Mcmillen Dr, Newark, OH 43055-1809 | 2006-07-20 |
| 1326068768 | Licking Memorial Professional Corp. | Internal Medicine | 1320 West Main Street, Newark, OH 43055-1822 | 2006-07-20 |
| Street Address |
15 MESSIMER DR |
| City | NEWARK |
| State | OH |
| Zip Code | 43055-1841 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144229733 | Nicholas Reed | Obstetrics & Gynecology | 15 Messimer Dr, Newark, OH 43055-1841 | 2005-07-18 |
| 1689931438 | Lauren Baker | Obstetrics & Gynecology | 15 Messimer Dr, Newark, OH 43055 | 2012-04-18 |
| 1295033256 | Michelle D Pease | Advanced Practice Midwife | 15 Messimer Dr, Newark, OH 43055-1841 | 2011-03-01 |
| 1881863736 | Erica L Brown | Advanced Practice Midwife | 15 Messimer Dr, Newark, OH 43055-1841 | 2008-02-25 |
| 1184707481 | Loretta Long | Advanced Practice Midwife | 15 Messimer Dr, Newark, OH 43055-1841 | 2006-10-23 |
| 1528002912 | John G Grauer | Specialist | 15 Messimer Dr, Newark, OH 43055 | 2006-06-15 |
| 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 | 207V00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |
| 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 Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821383555 | Michelle Marie Pacis | Obstetrics & Gynecology | 4735 Ogletown Stanton Rd Ste 2103, Newark, DE 19713-8000 | 2011-06-10 |
| 1679803704 | Women First, LLC | Obstetrics & Gynecology | 875 Aaa Blvd Ste B, Newark, DE 19713-3624 | 2010-01-13 |
| 1568669075 | Stephanie Lynne Marshall | Obstetrics & Gynecology | 185 S Orange Ave # 506, Newark, NJ 07103-2757 | 2007-06-28 |
| 1114067527 | Mrinal Koul | Obstetrics & Gynecology | 341 Walnut St, Newark, NJ 07105-2611 | 2007-02-07 |
| 1154476190 | Mark G Cadungog | Obstetrics & Gynecology | 4701 Ogletown Stanton Rd Ste 2335, Newark, DE 19713-7016 | 2007-01-23 |
| 1528124880 | Kelli M Gevas | Obstetrics & Gynecology | 15 Messimer Drive, Newark, OH 43055 | 2006-12-29 |
| 1407912322 | Euk Hyun Kim | Obstetrics & Gynecology | 228 Lafayette St, Newark, NJ 07105 | 2006-12-28 |
| 1659430528 | Luis A Yerovi Sr. | Obstetrics & Gynecology | 91 Congress St, Newark, NJ 07105-1801 | 2006-12-07 |
| 1811065634 | Abdul Wahij Najafi | Obstetrics & Gynecology | 410 Chancellor Ave, Newark, NJ 07112-1030 | 2006-12-01 |
| 1891808861 | Janae M. Davis | Obstetrics & Gynecology | 20 W Locust St, Newark, OH 43055-5520 | 2006-08-16 |
| 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.