LICKING MEMORIAL PROFESSIONAL CORP. (NPI# 1235311358) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235311358 |
| Entity Type | Organization |
| Organization Name | LICKING MEMORIAL PROFESSIONAL CORP. |
| Other Organization Name | LICKING MEMORIAL GERIATRIC MEDICINE AT AUTUMN |
| Practice Address |
17 Forry St Newark OH 43055-4004 |
| Practice Telephone | 7403487935 |
| Practice Fax Number | 7403487936 |
| Mailing Telephone | 7403487935 |
| Mailing Fax Number | 7403487936 |
| Enumeration Date | 2007-11-30 |
| Last Update Date | 2007-11-30 |
| Authorized Official Name | THOMAS N. POULSON (CFO) |
| Authorized Official Telephone | 7403484110 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207QG0300X |
Family Medicine Specialization: Geriatric Medicine |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Licking Memorial Geriatric Medicine at Autumn | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
| 1235159674 | Licking Memorial Professional Corp. | Obstetrics & Gynecology | 1 Healthy Pl, Suite 103, Pataskala, OH 43062-7067 | 2006-07-20 |
| Street Address |
17 FORRY ST |
| City | NEWARK |
| State | OH |
| Zip Code | 43055-4004 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659888071 | Altercare Newark South, Inc. | Skilled Nursing Facility | 17 Forry St, Newark, OH 43055-4004 | 2018-01-08 |
| 1407246200 | Newark Nh LLC | Assisted Living Facility | 17 Forry St, Newark, OH 43055-4004 | 2015-01-31 |
| 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 | 207QG0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Geriatric Medicine |
| A family medicine physician with special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes, and the hospital. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Family Medicine, 2007. http://wwwtheabfm.org/. American Osteopathic Board of Family Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Medicine. |
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|---|---|---|---|---|
| 1134104565 | Christiana Care Health Services, Inc | Family Medicine | 4735 Ogletown Stanton Rd Ste 1250, Newark, DE 19713-2076 | 2005-12-08 |
| 1083083216 | Christiana Care Health Initiatives | Family Medicine | 200 Hygeia Dr, Suite 2300, Newark, DE 19713-2049 | 2015-09-17 |
| 1962684084 | Licking Memorial Professional Corporation | Family Medicine | 75 Mcmillen Dr, Newark, OH 43055-1808 | 2007-11-30 |
| 1497937510 | Licking Memorial Professional Corp | Family Medicine | 1450 W Main St, Newark, OH 43055-1825 | 2007-11-30 |
| 1598945818 | Licking Memorial Professional Corp. | Family Medicine | 717 S 30th St, Newark, OH 43056-1244 | 2007-11-05 |
| 1952581274 | Licking Memorial Professional Corporation | Family Medicine | 151 Price Rd, Newark, OH 43055-3317 | 2007-11-05 |
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|---|---|---|---|---|
| 1922645779 | Francis Dapaah | Family Medicine | 1264 Brainard Rd, Lyndhurst, OH 44124-1404 | 2019-11-27 |
| 1255832275 | Primary Care Partners of Ohio | Family Medicine | 726 E Main St Ste F205, Lebanon, OH 45036 | 2018-02-25 |
| 1780009928 | Js Aesthetics | Family Medicine | 2400 Passage Key Trl, Xenia, OH 45385-9212 | 2014-02-25 |
| 1821422486 | Healthserve Medical Group LLC | Family Medicine | 2939 Kenny Rd Ste 200, Columbus, OH 43221-2406 | 2013-08-30 |
| 1902152366 | Mason Family Health Center LLC | Family Medicine | 7808 Derbyshire Ct, Liberty Township, OH 45044-9049 | 2012-08-02 |
| 1548539976 | Eva Ray Lefton | Family Medicine | 16 Deerfield Ln, Beachwood, OH 44122-7502 | 2011-12-13 |
| 1508189499 | Senior Care Physicians, Inc. | Family Medicine | 1745 Indian Wood Cir Ste 252, Maumee, OH 43537-4168 | 2010-03-05 |
| 1639404171 | Midwest Dysphagia Consultants, LLC | Family Medicine | 5710 Wooster Pike Ste 102, Cincinnati, OH 45227-4520 | 2009-10-15 |
| 1457589087 | John Tychonievich | Family Medicine | 2222 Welcome Pl, Columbus, OH 43209-7813 | 2009-06-22 |
| 1033240031 | Leslie Z Vidmar | Family Medicine | 8524 Cranwood Dr, Chesterland, OH 44026-1416 | 2007-03-08 |
| Find all providers with the same taxonomy | ||||
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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.