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Contact Information

LICKING MEMORIAL PROFESSIONAL CORP.
717 S 30TH ST
NEWARK, OH43056-1244
 Phone: 740-348-7935
 Fax: 740-348-7936
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Geriatric Medicine

207QG0300X 08 Physician/Family Practice
Indicates primary specialty

NPI Profile & details for LICKING MEMORIAL PROFESSIONAL CORP.

NPI # 1598945818
LBN Legal business name LICKING MEMORIAL PROFESSIONAL CORP.
Authorized official THOMAS POULSON - (CFO)
Entity Organization
Organization subpart 1 No
Enumeration date 11/05/2007
Last updated 11/05/2007 - About 19 years ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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