Organization
LICKING MEMORIAL PROFESSIONAL CORP.
Active
Other names
Licking Memorial Pediatrics Pataskala
Organization subpart
No
Provider details
NPI number
Authorized official
CYNTHIA L. WEBSTER (VP FINANCIAL SERVICE)
(740) 348-4000
Entity
Organization
Contact information
Practice address
1 HEALTHY PL, STE 203, PATASKALA, OH 43062
(740) 348-1925
(740) 348-1926
Mailing address
1 HEALTHY PL, STE 203, PATASKALA, OH 43062
(740) 348-1925
(740) 348-1926
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2596767
—
OH
Enumeration date
07/20/2006
Last updated
10/13/2014
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