LICKING MEMORIAL HOSPITAL (NPI# 1912258898) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912258898 |
| Entity Type | Organization |
| Organization Name | LICKING MEMORIAL HOSPITAL |
| Practice Address |
1320 W Main St Newark OH 43055-1822 |
| Practice Telephone | 7403484000 |
| Practice Fax Number | 7403487711 |
| Mailing Telephone | 7403484000 |
| Mailing Fax Number | 7403487711 |
| Enumeration Date | 2012-10-02 |
| Last Update Date | 2012-10-02 |
| Authorized Official Name | MS. CYNTHIA L WEBSTER (VICE PRESIDENT, FINANCIAL SERVICES) |
| Authorized Official Telephone | 7403484518 |
| Is Organization Subpart | Y |
| Parent Organization Name | LICKING MEMORIAL HOSPITAL |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 273Y00000X | Rehabilitation Unit | Hospital Units |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | 5172389 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720163637 | Licking Memorial Hospital | Home Health | 1865 Tamarack Rd Ste B, Newark, OH 43055-2316 | 2006-10-26 |
| 1568446755 | Licking Memorial Hospital | General Acute Care Hospital | 1320 W Main St, Newark, OH 43055-1822 | 2005-12-01 |
| 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 | 273Y00000X |
| Grouping | Hospital Units |
| Classification | Rehabilitation Unit |
| In general, a distinct unit of a general acute care hospital that provides care encompassing a comprehensive array of restoration services for the disabled and all support services necessary to help patients attain their maximum functional capacity. Source: AHA Annual Survey p. A10 1996 AHA Guide. For Medicare, a distinct part of a general acute care hospital providing inpatient rehabilitation services that meets the following requirements. Rehabilitation Units have in effect a preadmission screening procedure under which each prospective patient’s condition and medical history are reviewed to determine whether the patient is likely to benefit significantly from an intensive inpatient program or assessment; ensure that the patients receive close medical supervision and furnish, through the use of qualified personnel, rehabilitation nursing, physical therapy and occupational therapy, plus, as needed, speech therapy, social services or psychological services and orthotic and prosthetic services; have a plan of treatment for each inpatient that is established, reviewed, and revised as needed by a physician in consultation with other professional personnel who provide services to the patient; use a coordinated multidisciplinary team approach in the rehabilitation of each inpatient, as documented by periodic clinical entries made in the patient’s medical record to note the patient's status in relationship to goal attainment, and that team conferences are held at least every two weeks to determine the appropriateness of treatment; have a director of rehabilitation who provides services to the unit and its inpatients for at least 20 hours a week, is a doctor of medicine or osteopathy, is licensed under State law to practice medicine or surgery, and has had, after completing a one-year hospital internship at least two years of training or experience in the medical management of inpatients requiring rehabilitation services. |
| Notes: Source: Code of Federal Regulations #42, Section 412.29. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700250248 | Womack Army Medical Center | Rehabilitation Unit | 215 Ice Ave, 100, Dayton, OH 45402 | 2015-11-20 |
| 1902957335 | Kathiet Greene, Md, Inc | Rehabilitation Unit | 30575 Euclid Ave, Wickliffe, OH 44092-1037 | 2007-01-14 |
| 1376641068 | Edwin Shaw Rehab, LLC | Rehabilitation Unit | 330 Broadway Street East, Cuyahoga Falls, OH 44221 | 2006-09-20 |
| 1649298100 | Dayton Osteopathic Hospital | Rehabilitation Unit | 405 W Grand Avenue, Dayton, OH 45405-4720 | 2006-07-17 |
| 1740222009 | Aultman Hospital | Rehabilitation Unit | 2821 Woodlawn Ave Nw, Canton, OH 44708-1423 | 2006-06-12 |
| 1396346946 | Kettering Medical Center | Rehabilitation Unit | 4000 Miamisburg Centerville Rd, Miamisburg, OH 45342-7615 | 2020-11-02 |
| 1083236921 | Knox Community Hospital | Rehabilitation Unit | 1330 Coshocton Ave, Mount Vernon, OH 43050 | 2020-05-14 |
| 1346896875 | Fort Hamilton Hospital | Rehabilitation Unit | 630 Eaton Ave, Hamilton, OH 45013 | 2019-08-12 |
| 1306312921 | The Toledo Hospital | Rehabilitation Unit | 5200 Harroun Rd, Sylvania, OH 43560-2196 | 2018-10-22 |
| 1245789981 | Mercy Health - Anderson Hospital, LLC | Rehabilitation Unit | 7500 State Rd, Cincinnati, OH 45255-2439 | 2016-09-22 |
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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.