LICKING MEMORIAL PROFESSIONAL CORP. (NPI# 1497771521) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497771521 |
| Entity Type | Organization |
| Organization Name | LICKING MEMORIAL PROFESSIONAL CORP. |
| Other Organization Name | LICKING MEMORIAL PEDIATRICS-UTICA |
| Practice Address |
240 N. Main St Utica OH 43080 |
| Practice Telephone | 7403481740 |
| Practice Fax Number | 7403481741 |
| Mailing Telephone | 7403481740 |
| Mailing Fax Number | 7403481741 |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | ROBERT A. MONTAGNESE (EXECUTIVE V.P.) |
| Authorized Official Telephone | 7403484000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | 2143906 | 05 |
| Other Name | Type Code |
|---|---|
| Licking Memorial Pediatrics-Utica | 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 |
| 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 |
240 N. MAIN ST |
| City | UTICA |
| State | OH |
| Zip Code | 43080 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548807589 | Ellen Jane Yoakam | Registered Nurse | 4348 Johnstown Utica Rd, 4348 Johnstown Utica Rd, Utica, OH 43080 | 2019-12-10 |
| 1801232152 | Vanessa Frazee | Licensed Practical Nurse | 1710 Cullison Road, Utica, OH 43080 | 2013-05-14 |
| 1447573175 | Giving Peace of Mind, LLC | Home Health | 20 S. Main St., Utica, OH 43080 | 2010-03-09 |
| 1861693590 | William Harold Cardwell Jr. | Dentist | 206 N. Main St., Utica, OH 43080 | 2007-05-30 |
| 1225166549 | Melanie Main | Pharmacist | 244 North Main Street, Utica, OH 43080 | 2007-02-28 |
| 1386618494 | Living Care Alternatives of Utica Inc | Skilled Nursing Facility | 233 N Main St, Utica, OH 43080 | 2006-02-15 |
| 1619292604 | Rebecca Elaine Wright | Licensed Practical Nurse | 307 Penn Ave., Utica, OH 43080-0481 | 2010-04-01 |
| 1336208313 | Bruce Paul Miller | Internal Medicine | 248 North Main Street, Utica, OH 43080-0507 | 2006-12-06 |
| 1861553547 | Scott M Shaffer | Chiropractor | 122 South Main St, Utica, OH 43080-0541 | 2006-12-13 |
| 1134470966 | Joshua Mark Bryant | Registered Nurse | 580 N. Jefferson St., Utica, OH 43080-0727 | 2012-09-19 |
| Find all providers in zip 43080 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720370158 | Amanda M Roublick | Pediatrics | 1256 Culver Ave., Utica, NY 13501 | 2011-05-03 |
| 1619064490 | Susan M Blatt | Pediatrics | 406 Elizabeth St, Utica, NY 13501-2306 | 2006-10-05 |
| 1033200456 | Utica Pediatrics PC | Pediatrics | 1450 Camplin Ave, Utica, NY 13502 | 2006-09-28 |
| 1336104470 | Kamala J Vanaharam | Pediatrics | 7828 22 Miles Rd, Utica, MI 48317 | 2006-04-20 |
| 1770550709 | David William Brege | Pediatrics | 44720 Van Dyke Ave, Utica, MI 48317-5480 | 2006-03-08 |
| 1902184195 | Teresa Martorella | Pediatrics | 2212 Genesee St, Utica, NY 13502-5809 | 2011-07-22 |
| 1952614117 | Margaret Cooper | Pediatrics | 1256 Culver Ave, Utica, NY 13501-4253 | 2010-07-16 |
| 1487773461 | Dawn Marie Bard | Pediatrics | 1450 Champlin Ave, Utica, NY 13502-3662 | 2007-03-28 |
| 1841346111 | Karen Burns Griffith | Pediatrics | 1450 Champlin Ave, Utica, NY 13502-3662 | 2007-01-26 |
| 1578628160 | Daniel Lewis Zeidner | Pediatrics | 1450 Champlin Ave, Utica Pediatrics, Utica, NY 13502-3662 | 2006-12-26 |
| Find all providers in UTICA | ||||
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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.