MEDICARE: LIMA MEMORIAL PROFESSIONAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1811427586
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIMA MEMORIAL PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	951 COMMERCE PKWY STE 101
Second Line	:
City	:	LIMA
State	:	OH
Zip	:	45804-4040
Country	:	US
Telephone Number	:	419-998-4575
Fax Number	:	419-998-4586

Provider Business Practice Location Address
First Line	:	1220 E ELM ST STE 101
Second Line	:
City	:	LIMA
State	:	OH
Zip	:	45804-2803
Country	:	US
Telephone Number	:	419-998-8245
Fax Number	:	419-998-8247

Authorized Official
Title or Position	:	DIRECTOR OF LMP
Name	:	JEFFREY UTZ
Credential	:
Telephone Number	:	419-998-4668

Provider Enumeration Date	:	06/15/2017
Last Update Date	:	02/21/2018

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1659396612 — AMY L SMITH MSN, CNM
Practice Location Address:

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1518984137 — DR. KENNETH E STANLEY MD
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Directions to “LIMA MEMORIAL PROFESSIONAL CORPORATION ” Practice Location

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