Organization
LICKING MEMORIAL PROFESSIONAL CORPORATION
Active
Other names
Licking Memorial Reconstructive & Cosmetic Services
Organization subpart
No
Provider details
NPI number
Authorized official
RENEE SPRING-IVES (CREDENTIALING COORDINATOR)
(740) 348-4027
Entity
Organization
Contact information
Practice address
1272 W MAIN ST, BLDG. 2, NEWARK, OH 43055-2004
(740) 348-7955
(740) 348-7956
Mailing address
1272 W MAIN ST, BLDG. 2, NEWARK, OH 43055-2004
(740) 348-7955
(740) 348-7956
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
—
—
Other
Enumeration date
08/15/2007
Last updated
08/15/2007
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