LICKING MEMORIAL PROFESSIONAL CORP.


Address: 120 Mcmillen Dr, Newark, OH 43055-1809
Phone: 7403487935

LICKING MEMORIAL PROFESSIONAL CORP. (NPI# 1649290073) 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) 1649290073
Entity Type Organization
Organization Name LICKING MEMORIAL PROFESSIONAL CORP.
Other Organization Name LICKING MEMORIAL GERIATRIC MEDICINE
Practice Address 120 Mcmillen Dr
Newark
OH 43055-1809
Practice Telephone 7403487935
Practice Fax Number 7403487936
Mailing Telephone 7403487935
Mailing Fax Number 7403487936
Enumeration Date 2006-07-20
Last Update Date 2020-08-22
Authorized Official Name ROBERT A MONTAGNESE (EXECUTIVE V.P.)
Authorized Official Telephone 7403484000
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207RG0300X Internal Medicine
Specialization: Geriatric Medicine
Allopathic & Osteopathic Physicians

Other Provider/Organization Names

Other Name Type Code
Licking Memorial Geriatric Medicine 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
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
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 120 MCMILLEN DR
City NEWARK
State OH
Zip Code 43055-1809

Providers in the same location

NPI Name Taxonomy Address Enumeration
1023017860 Mark Mitchell Internal Medicine 120 Mcmillen Dr, Newark, OH 43055-1809 2005-07-14
1568857746 Nishi Patel Internal Medicine 120 Mcmillen Dr, Newark, OH 43055 2015-04-03
1588007017 Nina Pola Hourmouzis Internal Medicine 120 Mcmillen Dr, Newark, OH 43055 2013-04-15
1871813691 Even Fengyuan Wang Psychiatry & Neurology 120 Mcmillen Dr, Newark, OH 43055-1809 2010-06-03
1174782775 Daria J Hopkins Internal Medicine 120 Mcmillen Dr, Newark, OH 43055-1809 2008-06-09
1003005034 Misti D. Staggers Clinical Nurse Specialist 120 Mcmillen Dr, Newark, OH 43055-1809 2007-10-16
1730109166 Licking Memorial Professional Corp Internal Medicine 120 Mcmillen Dr, Newark, OH 43055-1809 2006-07-20
1740289941 Gerald Ehrsam Internal Medicine 120 Mcmillen Dr, Newark, OH 43055-1809 2005-07-19

Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 207RG0300X
Grouping Allopathic & Osteopathic Physicians
Classification Internal Medicine
Specialization Geriatric Medicine

Taxonomy Definition

An internist who has 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 Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1902009459 Alexander Kolessa Internal Medicine 188 Jefferson St, Suite# 111, Newark, NJ 07105-1622 2007-06-11
1609909431 Hockessin Comprehensive Care Internal Medicine 71 Hidden Valley Dr, Newark, DE 19711-7463 2007-03-13
1114451234 Claudia Lynch Internal Medicine 972 Broad St, Newark, NJ 07102-2533 2017-04-14
1346208923 Nbimc Department of Geriatrics Internal Medicine 201 Lyons Ave, Newark, NJ 07112-2027 2006-05-03

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1689298119 Np Insight Internal Medicine 4996 Pigeon Run Rd Sw, Navarre, OH 44662-8123 2020-06-01
1164082764 Phoenix Help LLC Internal Medicine 7215 Winding Way, Cincinnati, OH 45236-3340 2019-06-17
1790343846 Geriatric Care Providers Inc Internal Medicine 2605 Greenbrier Ct, Beavercreek, OH 45431-8564 2019-06-04
1538698568 David John Donofrio Internal Medicine 6427 Stonecrest Dr, Brookpark, OH 44142-3767 2017-06-04
1346690757 Detroit 74th Medical Clinic Inc Internal Medicine 4805 Lorain Ave, Cleveland, OH 44102-3351 2016-06-16
1245610179 Sarah Hyun Hong Min Internal Medicine 2355 Norwood Ave Ste 1, Cincinnati, OH 45212-2750 2015-06-05
1326434127 Hiba Khan Internal Medicine 1950 E 89th Street, Cleveland, OH 44195-1003 2015-04-09
1184927287 Range Health Care Services LLC Internal Medicine 4875 Union Rd, Franklin, OH 45005-5127 2010-12-10
1366622623 Peter Dillard Md Inc Internal Medicine 3237 Ormond Rd, Cleveland Heights, OH 44118-3415 2007-11-05
1427261692 Preeti Betkerur Internal Medicine 75th Arch St, Suite G 2, Akron, OH 44304 2007-05-07
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Competitor

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City NEWARK
Zip Code 43055

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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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