LICKING MEMORIAL PROFESSIONAL CORP (NPI# 1972702512) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972702512 |
| Entity Type | Organization |
| Organization Name | LICKING MEMORIAL PROFESSIONAL CORP |
| Other Organization Name | LICKING MEMORIAL HEART CENTER |
| Practice Address |
1320 West Main Street Newark OH 43055-1822 |
| Practice Telephone | 7403487750 |
| Practice Fax Number | 7403487751 |
| Mailing Telephone | 7403487750 |
| Mailing Fax Number | 7403487751 |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2010-11-12 |
| Authorized Official Name | CYNTHIA L WEBSTER (VP FINANCIAL SERVICES) |
| Authorized Official Telephone | 7403484027 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Licking Memorial Heart Center | 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 |
| 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 |
| 1851325526 | Licking Memorial Professional Corp | Family Medicine | 1 Healthy Pl, Suite 101, Pataskala, OH 43062-7067 | 2006-07-10 |
| 1255365102 | Licking Memorial Professional Corp | Family Medicine | 151 Woodgate Dr, Johnstown, OH 43031-1198 | 2006-07-10 |
| Street Address |
1320 WEST MAIN STREET |
| City | NEWARK |
| State | OH |
| Zip Code | 43055-1822 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942200993 | Rebecca Thomas | Nurse Anesthetist, Certified Registered | 1320 West Main Street, Newark, OH 43055 | 2005-07-29 |
| 1679079016 | Megan Marie Lowry | Nurse Practitioner | 1320 West Main Street, Newark, OH 43055 | 2018-04-04 |
| 1104206564 | Brendan Divis | Anesthesiology | 1320 West Main Street, Newark, OH 43055 | 2015-06-01 |
| 1366862906 | Andrew Reaven | Anesthesiology | 1320 West Main Street, Newark, OH 43055-1822 | 2014-04-22 |
| 1518302066 | Leah Thornton | Anesthesiology | 1320 West Main Street, Newark, OH 43055 | 2013-05-09 |
| 1780926337 | John Peter Lazar | Pediatrics | 1320 West Main Street, Newark, OH 43055 | 2013-03-21 |
| 1669713483 | Brian F Goodhue | Emergency Medicine | 1320 West Main Street, Newark, OH 43055 | 2013-03-04 |
| 1760732374 | Amanda Sofia Davila Rodriguez | Pediatrics | 1320 West Main Street, Newark, OH 43055 | 2012-09-12 |
| 1124373535 | Jason D Carrier | Nurse Anesthetist, Certified Registered | 1320 West Main Street, Newark, OH 43055 | 2012-07-23 |
| 1033484548 | Deforest Roche Brown | Nurse Anesthetist, Certified Registered | 1320 West Main Street, Newark, OH 43055 | 2012-03-16 |
| Find all providers in the same location | ||||
| 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 | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://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. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194077586 | Hosmane Cardiology LLC | Internal Medicine | 4547 Ogletown Stanton Rd, Medical Arts Pavillion 1 Suite 135, Newark, DE 19713 | 2012-10-09 |
| 1568745016 | Emad F Aziz | Internal Medicine | 90 Bergen St # 3500, Newark, NJ 07103 | 2011-09-21 |
| 1497045504 | Usman I Choudhry | Internal Medicine | 4755 Ogletown Stanton Rd Ste 1070, Newark, DE 19718-2200 | 2011-04-10 |
| 1326357765 | Irvin Goldfarb, Md, Pa | Internal Medicine | 306 Martin Luther King Blvd, 4th Floor, Newark, NJ 07102 | 2010-10-04 |
| 1457670739 | Access Medicine Nj | Internal Medicine | 228 Lafayette St Fl 5, Newark, NJ 07105 | 2010-05-25 |
| 1467636936 | Cathedral Faculty Practice | Internal Medicine | 268 Dr. Martin Luther King Boulevard, Newark, NJ 07102-2094 | 2007-12-20 |
| 1790965259 | Irena O. Stolar, M.d., P.a. | Internal Medicine | 320 Christiana Medical Ctr, Newark, DE 19702-1653 | 2007-11-13 |
| 1235334145 | James Matthew Maher | Internal Medicine | 185 S Orange Ave # I532, Newark, NJ 07103-2757 | 2007-06-19 |
| 1366594848 | Sunrays Cardiology Inc | Internal Medicine | 71 South Terrace Avenue, Newark, OH 43055 | 2007-01-17 |
| 1184796682 | David S. Grubbs, M.d., P.a. | Internal Medicine | K15 Omega Drive, Suite 5, Newark, DE 19713 | 2006-11-14 |
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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.