| Organization Name: | LICKING MEMORIAL PROFESSIONAL CORP. |
| NPI Number: | 1154496503 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CYNTHIA L. WEBSTER (VP FINANCIAL SERVICE) |
| Mailing Address: | 2000 Tamarack Rd Newark |
| State: | OH US |
| Postal Code: | 43055 |
| Phone Number: | 7403481993 |
| Fax Number: | 7403481994 |
| NPI Enumeration Date: | 11/21/2006 |
| NPI Last Update Date: | 02/18/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |