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General NPI Number Information
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NPI Number | 1326072265
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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 | 07/10/2006
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 1320 W MAIN ST
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City | NEWARK
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State | OH
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Zip | 43055-1822
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Country | US
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Telephone | 220-564-4027
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Fax | 220-564-4012
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Provider Business Mailing Address
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Address Line | 1320 W MAIN ST
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City | NEWARK
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State | OH
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Zip | 43055-1822
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Country | US
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Telephone | 220-564-4027
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Fax | 220-564-4012
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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 | 220-564-4027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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