Organization
LICKING MEMORIAL PROFESSIONAL CORP.
Active
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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