LICKING MEMORIAL PROFESSIONAL CORPORATION (NPI# 1376585430) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376585430 |
| Entity Type | Organization |
| Organization Name | LICKING MEMORIAL PROFESSIONAL CORPORATION |
| Other Organization Name | LICKING MEMORIAL ANESTHESIOLOGY |
| Practice Address |
1320 W Main St Newark OH 43055-1822 |
| Practice Telephone | 7403484226 |
| Practice Fax Number | 7403484219 |
| Mailing Telephone | 7403484226 |
| Mailing Fax Number | 7403484219 |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | ROBERT A. MONTAGNESE (EXECUTIVE VICE PRESIDENT) |
| Authorized Official Telephone | 7403484000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207L00000X | Anesthesiology | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | 2139920 | 05 |
| Other Name | Type Code |
|---|---|
| Licking Memorial Anesthesiology | Doing Business As Name - Organization |
| 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 |
| 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 |
| Street Address |
1320 W MAIN ST |
| City | NEWARK |
| State | OH |
| Zip Code | 43055-1822 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629076898 | Jeff Bare | Emergency Medicine | 1320 W Main St, Newark, OH 43055-1822 | 2005-07-12 |
| 1538767116 | Amanda Kay Codlin | Nurse Practitioner | 1320 W Main St, Newark, OH 43055-1822 | 2020-10-15 |
| 1053928101 | Andrea Sims | Nurse Practitioner | 1320 W Main St, Newark, OH 43055-1822 | 2020-09-23 |
| 1376155630 | Jeanette Carpenter | Nurse Practitioner | 1320 W Main St, Newark, OH 43055-1822 | 2020-08-18 |
| 1912521451 | Courtney Marie Adams | Nurse Anesthetist, Certified Registered | 1320 W Main St, Newark, OH 43055-1822 | 2020-06-01 |
| 1770105603 | Jason Sturgeon | Clinic/Center | 1320 W Main St, Newark, OH 43055-1822 | 2020-05-14 |
| 1376195248 | Rahel Gebeyehu Mitiku | Nurse Practitioner | 1320 W Main St, Newark, OH 43055-1822 | 2019-07-11 |
| 1720544232 | Corey Salyer | Nurse Practitioner | 1320 W Main St, Newark, OH 43055-1822 | 2019-02-20 |
| 1851860589 | Tabitha Gartner | Nurse Practitioner | 1320 W Main St, Newark, OH 43055-1822 | 2018-11-26 |
| 1972010783 | Patricia Joan Liesen | Dietitian, Registered | 1320 W Main St, Newark, OH 43055-1822 | 2018-01-02 |
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| 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 | 207L00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Anesthesiology |
| An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an operation or an obstetric or diagnostic procedure. The anesthesiologist assesses the risk of the patient undergoing surgery and optimizes the patient's condition prior to, during and after surgery. In addition to these management responsibilities, the anesthesiologist provides medical management and consultation in pain management and critical care medicine. Anesthesiologists diagnose and treat acute, long-standing and cancer pain problems; diagnose and treat patients with critical illnesses or severe injuries; direct resuscitation in the care of patients with cardiac or respiratory emergencies, including the need for artificial ventilation; and supervise post-anesthesia recovery. |
| 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 Anesthesiology, 2007. http://www.theaba.org/; American Osteopathic Board of Anesthesiology, 2007, http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Anesthesiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Anesthesiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164954566 | Michael Chukwuemeka Ndukwe | Anesthesiology | 185 S Orange Ave # Msbf-603, Newark, NJ 07103-2757 | 2017-04-03 |
| 1003158718 | Anna Korban | Anesthesiology | 185 S Orange Ave # Msbf-611, Newark, NJ 07103-2757 | 2013-03-20 |
| 1750645982 | Akwasi Peprah Amponsah Jr. | Anesthesiology | 150 Bergen St # Streete, Newark, NJ 07103 | 2012-07-03 |
| 1285994582 | Shachi C Patel | Anesthesiology | 1 Centurian Dr Ste 110, Newark, DE 19713-2154 | 2012-05-21 |
| 1407122609 | Uchenna Anthony Madubuko | Anesthesiology | 550 S 19th St, Newark, NJ 07103 | 2012-04-02 |
| 1154692077 | Michael Suleiman Marji | Anesthesiology | St. Michael's Medical Center, 111 Central Avenue, Newark, NJ 07102 | 2012-01-24 |
| 1326351271 | Michal Gajewski | Anesthesiology | 185 S. Orange Ave., Msb E-538, Newark, NJ 07103 | 2010-07-21 |
| 1336374149 | Daisy Munoz | Anesthesiology | 651 N 6th St, Newark, NJ 07107-2505 | 2009-05-22 |
| 1043453657 | Da Wang | Anesthesiology | 185 S Orange Ave Rm E-538, Newark, NJ 07103-2757 | 2009-04-13 |
| 1609020049 | Corazon G. Tablang Md PC | Anesthesiology | 10 Darwin Dr Ste C, Darwin Professional Center, Newark, DE 19711-6658 | 2008-11-12 |
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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.