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Contact Information

LICKING MEMORIAL PROFESSIONAL CORP.
240 N. MAIN ST
UTICA, OH43080
 Phone: 740-348-1740
 Fax: 740-348-1741
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pediatrics

208000000X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for LICKING MEMORIAL PROFESSIONAL CORP.

NPI # 1497771521
LBN Legal business name LICKING MEMORIAL PROFESSIONAL CORP.
Authorized official ROBERT MONTAGNESE - (EXECUTIVE V.P.)
Entity Organization
Organization subpart 1 No
Enumeration date 07/14/2006
Last updated 08/22/2020 - About 6 years ago
Identifiers
OH Medicaid 2143906
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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