LICKING MEMORIAL PROFESSIONAL CORP (NPI# 1851325526) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851325526 |
| Entity Type | Organization |
| Organization Name | LICKING MEMORIAL PROFESSIONAL CORP |
| Other Organization Name | LICKING MEMORIAL FAMILY PRACTICE PATASKALA |
| Practice Address |
1 Healthy Pl Suite 101 Pataskala OH 43062-7067 |
| Practice Telephone | 7403481900 |
| Practice Fax Number | 7403481901 |
| Mailing Telephone | 7403481900 |
| Mailing Fax Number | 7403481901 |
| Enumeration Date | 2006-07-10 |
| 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 | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Licking Memorial Family Practice Pataskala | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073822938 | Licking Memorial Professional Corp | Internal Medicine | 1272 W Main St, Bldg 2 Ste 3, Newark, OH 43055-2004 | 2010-09-27 |
| 1497937510 | Licking Memorial Professional Corp | Family Medicine | 1450 W Main St, Newark, OH 43055-1825 | 2007-11-30 |
| 1831381797 | Licking Memorial Professional Corp | Family Medicine | 270 Goosepond Rd, Newark, OH 43055-3104 | 2007-08-15 |
| 1972702512 | Licking Memorial Professional Corp | Internal Medicine | 1320 West Main Street, Newark, OH 43055-1822 | 2007-07-13 |
| 1659445070 | Licking Memorial Professional Corp | Pediatrics | 1320 W Main St, Newark, OH 43055-1822 | 2006-11-17 |
| 1730109166 | Licking Memorial Professional Corp | Internal Medicine | 120 Mcmillen Dr, Newark, OH 43055-1809 | 2006-07-20 |
| 1083634414 | Licking Memorial Professional Corp | Pediatrics | 1865 Tamarack Rd, Newark, OH 43055-2305 | 2006-07-20 |
| 1073531729 | Licking Memorial Professional Corp | Family Medicine | 399 E Main St, Newark, OH 43055-6516 | 2006-07-18 |
| 1255365102 | Licking Memorial Professional Corp | Family Medicine | 151 Woodgate Dr, Johnstown, OH 43031-1198 | 2006-07-10 |
| Street Address |
1 HEALTHY PL SUITE 101 |
| City | PATASKALA |
| State | OH |
| Zip Code | 43062-7067 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427056597 | John Applegate | Pediatrics | 1 Healthy Pl, Ste. 203, Pataskala, OH 43062-7067 | 2005-07-12 |
| 1700291416 | Licking Memorial Professional Corporation | Dermatology | 1 Healthy Pl, Suite 205, Pataskala, OH 43062-7067 | 2014-06-23 |
| 1952479115 | Connie S Jenkins | Psychiatry & Neurology | 1 Healthy Pl, Suite 105, Pataskala, OH 43062-7067 | 2006-12-04 |
| 1295809614 | Licking Memorial Professional Corp. | Psychiatry & Neurology | 1 Healthy Pl, Suite 105, Pataskala, OH 43062-7067 | 2006-11-17 |
| 1235159674 | Licking Memorial Professional Corp. | Obstetrics & Gynecology | 1 Healthy Pl, Suite 103, Pataskala, OH 43062-7067 | 2006-07-20 |
| 1144240581 | Licking Memorial Professional Corp. | Pediatrics | 1 Healthy Pl, Ste 203, Pataskala, OH 43062 | 2006-07-20 |
| 1104869700 | Tiffany E.d. Inglis | Obstetrics & Gynecology | 1 Healthy Pl, Suite 201, Pataskala, OH 43062-7067 | 2006-06-13 |
| 1942249735 | Dalia S Elkhairi | Obstetrics & Gynecology | 1 Healthy Pl, Suite 201, Pataskala, OH 43062-7067 | 2006-06-06 |
| 1255330965 | Colleen Smith | Family Medicine | 1 Healthy Pl, Suite 101, Pataskala, OH 43062-7067 | 2005-07-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255955639 | 1st and Long Logistics Ltd. | Private Vehicle | 104 Eastave, Pataskala, OH 43062 | 2020-06-02 |
| 1023639168 | Jodi C Neff | Driver | 104 East Ave, Etna, OH 43062 | 2020-04-29 |
| 1073022596 | Bonny Lou Harris | Licensed Vocational Nurse | 8764 National Rd Sw Lot 43, Pataskala, OH 43062 | 2017-09-27 |
| 1780131359 | Patricia Obrien | Licensed Practical Nurse | 4606 Brownstone Drive, Hilliard, OH 43062 | 2016-09-01 |
| 1477941615 | Keli R Massie | Speech-Language Pathologist | 391 S. High Street, Pataskala, OH 43062 | 2014-12-22 |
| 1952709016 | Stacey Heldman | Speech-Language Pathologist | 927b South St., Etna, OH 43062 | 2014-12-05 |
| 1033541842 | Power Ahead Physical Therapy LLC | Physical Therapist | 202 E. Broad St., Pataskala, OH 43062 | 2013-08-02 |
| 1174819288 | Mollie Sue Albaugh | Occupational Therapy Assistant | 14 Milkweed Place, Pataskala, OH 43062 | 2011-06-27 |
| 1710198619 | Jennifer Agnes Skeens | Licensed Practical Nurse | 114 Deer Path Ct N, Pataskala, OH 43062 | 2007-05-24 |
| 1346456357 | Total Renal Care Inc | Clinic/Center | 658 E Broad St, Pataskala, OH 43062 | 2007-05-15 |
| Find all providers in zip 43062 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, 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 Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255322335 | Norman A Schwartz | Family Medicine | 621 Broad St Sw, 1e, Pataskala, OH 43062-8118 | 2005-10-28 |
| 1912909268 | Vitold George Zochowski | Family Medicine | 8200 Hazelton Etna Rd Sw, Ste 100, Pataskala, OH 43062-9630 | 2005-06-01 |
| 1114210374 | Keri Lynn Hershberger | Family Medicine | One Healthy Place, Suite 102, Pataskala, OH 43062 | 2011-05-20 |
| 1205076544 | Earl Gregory Haley | Family Medicine | One Healthy Place, Suite 102, Pataskala, OH 43062 | 2009-02-26 |
| 1003912403 | V.george Zochowski, D.o.,inc. | Family Medicine | 8200 Hazelton Etna Rd Sw, Suite 100, Pataskala, OH 43062-9630 | 2006-09-15 |
| 1255330965 | Colleen Smith | Family Medicine | 1 Healthy Pl, Suite 101, Pataskala, OH 43062-7067 | 2005-07-15 |
| 1487656682 | Jennifer Katherine Zochowski | Family Medicine | 8200 Hazelton Etna Rd Sw, Ste 100, Pataskala, OH 43062-9630 | 2005-06-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255948667 | Grace Laszlo | Family Medicine | 2385 Creek View Pl, Grove City, OH 43123-1518 | 2020-09-29 |
| 1396350138 | Kelly Crego-lee | Family Medicine | 321 Neal Rd, Saint Paris, OH 43072-9305 | 2020-09-09 |
| 1669087524 | Deanna Tiffiene Thompson | Family Medicine | 895 Slagle Pl, Galloway, OH 43119-8821 | 2020-09-08 |
| 1982218145 | Kara Day | Family Medicine | 5867 Dantawood Ln, Liberty Twp, OH 45044-1309 | 2020-09-04 |
| 1669086260 | Family Care Plus Clinic LLC | Family Medicine | 4490 Darrow Rd, Stow, OH 44224-1885 | 2020-09-02 |
| 1619580693 | Erica Jayne Mack | Family Medicine | 542 W Mulberry St, Lancaster, OH 43130-2907 | 2020-08-28 |
| 1588277669 | Sarah Elizabeth Ruth Wilcox | Family Medicine | 3146 Grange Hill Pl, Dublin, OH 43017-1794 | 2020-08-28 |
| 1073126314 | Stawa Rajab Blanco | Family Medicine | 4900 Delhi Rd, Cincinnati, OH 45238-5345 | 2020-08-26 |
| 1154933463 | Amanda Taylor Greenrod | Family Medicine | 11010 Gabriella Dr, Parma, OH 44130-1468 | 2020-08-18 |
| 1457962110 | Mt. Eaton Medical Group | Family Medicine | 15988 E Chestnut St, Mt. Eaton, OH 44659 | 2020-08-14 |
| 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.