Organization
LICKING MEMORIAL PROFESSIONAL CORP.
Active
Other names
Licking Memorial Surgical Services
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT A. MONTAGNESE (EXECUTIVE V.P.)
(740) 348-4000
Entity
Organization
Contact information
Practice address
1272 W MAIN ST, BLDG. 3, NEWARK, OH 43055-2004
(740) 348-1880
(740) 348-1881
Mailing address
1272 W MAIN ST, BLDG. 3, NEWARK, OH 43055-2004
(740) 348-1880
(740) 348-1881
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2483610
—
OH
Enumeration date
07/19/2006
Last updated
08/22/2020
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