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General NPI Number Information
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NPI Number | 1053758631
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Entity Type | Organization
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Legal Business Name | LICKING MEMORIAL PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 05/23/2013
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Last Update Date | 05/23/2013
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Provider Practice Location Address
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Address Line | 270 GOOSEPOND ROAD STE 102
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City | NEWARK
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State | OH
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Zip | 43055
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Country | US
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Telephone | 740-348-7945
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Fax | 740-348-7946
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Provider Business Mailing Address
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Address Line | 270 GOOSEPOND RD. STE 102
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City | NEWARK
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State | OH
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Zip | 43055
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Country | US
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Telephone | 740-348-7945
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Fax | 740-348-7946
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Authorized Official
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Title or Position | VP FINANCIAL SERVICE
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Name | CYNTHIA L. WEBSTER
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Credential |
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Telephone | 740-348-4518
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State |
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