LICKING MEMORIAL PROFESSIONAL CORP.


Address: 717 S 30th St, Newark, OH 43056-1244
Phone: 7403487935

LICKING MEMORIAL PROFESSIONAL CORP. (NPI# 1598945818) 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) 1598945818
Entity Type Organization
Organization Name LICKING MEMORIAL PROFESSIONAL CORP.
Other Organization Name LICKING MEMORIAL GERIATRIC MEDICINE AT HNC
Practice Address 717 S 30th St
Newark
OH 43056-1244
Practice Telephone 7403487935
Practice Fax Number 7403487936
Mailing Telephone 7403487935
Mailing Fax Number 7403487936
Enumeration Date 2007-11-05
Last Update Date 2007-11-05
Authorized Official Name THOMAS N. POULSON (CFO)
Authorized Official Telephone 7403484110
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207QG0300X Family Medicine
Specialization: Geriatric Medicine
Allopathic & Osteopathic Physicians

Other Provider/Organization Names

Other Name Type Code
Licking Memorial Geriatric Medicine at HNC Doing Business As Name - Organization

Other Provider IDs and Locations

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
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

Office Location

Street Address 717 S 30TH ST
City NEWARK
State OH
Zip Code 43056-1244

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1447648910 Chromocare Limited Clinical Medical Laboratory 785 Irving Wick Dr W, Heath, OH 43056 2015-01-06
1003228990 Melissa Rae Trego Registered Nurse 460 South 30 Street, Heath, OH 43056 2014-05-27
1922247139 Cassie Wimeland-keener Occupational Therapy Assistant 667 Hopwell Drive, Heathq, OH 43056 2009-02-11
1033237755 Chiropractic and Physical Therapy Chiropractor 844 N. 30 Street, Heath, OH 43056 2007-03-27
1588631808 David A Bartnick Family Medicine 687 Hopewell Drive, Bldg. 2, Heath, OH 43056 2006-03-06
1326646126 Center for Disability Services Day Training, Developmentally Disabled Services 667 Hopewell Drive, Heath, OH 43056 2020-10-14
1972810356 Brittany Moore Occupational Therapy Assistant 667 Hopewell Drive, Heath, OH 43056 2010-09-08
1659510980 Cindy Miller Occupational Therapy Assistant 667 Hopewell Drive, Heath, OH 43056 2009-02-10
1962648915 Robin Shaner Occupational Therapy Assistant 667 Hopewell Drive, Heath, OH 43056 2008-12-22
1558306894 Megan Marie Fechter Audiologist Hearusa, 697 Hopewell Dr., Heath, OH 43056 2006-06-19
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Taxonomy Information

Taxonomy Code 207QG0300X
Grouping Allopathic & Osteopathic Physicians
Classification Family Medicine
Specialization Geriatric Medicine

Taxonomy Definition

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.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1235311358 Licking Memorial Professional Corp. Family Medicine 17 Forry St, Newark, OH 43055-4004 2007-11-30
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
1952581274 Licking Memorial Professional Corporation Family Medicine 151 Price Rd, Newark, OH 43055-3317 2007-11-05

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
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
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Competitor

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City NEWARK
Zip Code 43056

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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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