Organization
LICKING MEMORIAL PROFESSIONAL CORP
Active
Organization
LICKING MEMORIAL PROFESSIONAL CORP
Active
Other names
Licking Memorial Geriatric Medicine at Flint Ridge
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS N. POULSON (CFO)
(740) 348-4110
Entity
Organization
Contact information
Practice address
1450 W MAIN ST, NEWARK, OH 43055-1825
(740) 348-7935
(740) 348-7936
Mailing address
1450 W MAIN ST, NEWARK, OH 43055-1825
(740) 348-7935
(740) 348-7936
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
—
—
Other
Enumeration date
11/30/2007
Last updated
11/30/2007
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