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LICKING MEMORIAL PROFESSIONAL CORP. NPI 1891715223


NPI Profile

NPI: 1891715223
Provider Name: LICKING MEMORIAL PROFESSIONAL CORP.

Doing Business As: LICKING MEMORIAL OCCUPATIONAL MEDICINE

Classification:Preventive Medicine - 2083P0500X
Entity Type: Organization

Specialization: Preventive Medicine/Occupational Environmental Medicine

Address:
1865 TAMARACK RD
NEWARK, OH
ZIP 43055
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Phone: (740) 348-4972

LICKING MEMORIAL PROFESSIONAL CORP. is a preventive medicine/occupational environmental medicine preventive medicine in Newark, OH. The provider is a preventive medicine physician who specializes in preventive medicine/occupational-environmental medicine, which is focused on protecting the population from occupational and environmental conditions. LICKING MEMORIAL PROFESSIONAL CORP. NPI is 1891715223. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Licking Memorial Occupational Medicine.

The provider's business location address is:

1865 TAMARACK RD
NEWARK, OH
ZIP 43055-305
Phone: (740) 348-4972
Fax: (740) 348-4991

The provider's authorized official is Robert A. Montagense .
The authorized official title is Executive V.p. and has the following contact phone number (740) 348-4000.

The enumeration date for this NPI number is 7/20/2006 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
12083P0500XPreventive MedicinePreventive Medicine/Occupational Environmental MedicineYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
12354134MEDICAIDOHIO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/11/2021

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