LICKING MEMORIAL INTERNAL MEDICINE (LICKING MEMORIAL PROFESSIONAL CORP) NPI 1730109166

Internal Medicine in Newark, OH

NPI 1730109166 Organization Internal Medicine CLIA Number 36D0327660 CLIA Certificate of Waiver

About LICKING MEMORIAL INTERNAL MEDICINE (LICKING MEMORIAL PROFESSIONAL CORP)

Licking Memorial Internal Medicine (licking Memorial Professional Corp) is an internal medicine provider established in Newark, Ohio specializing in internal medicine. The NPI number of Licking Memorial Internal Medicine (licking Memorial Professional Corp) is 1730109166 and was assigned on July 2006. The practitioner's primary taxonomy code is 207R00000X. The provider is registered as an organization and their NPI record was last updated one year ago. Licking Memorial Internal Medicine (licking Memorial Professional Corp) operates as a single speciality business group with one or more individual providers who practice the same area of specialization. The provider's is doing business as Licking Memorial Internal Medicine. The authorized official of this NPI record is Robert A. Montagnese (Executive V.p)

An internist like Licking Memorial Internal Medicine is a physician who has completed an internal medicine residency and is board-certified or board-eligible in an internist specialty. Internists are trained to care for adults of all ages for many different medical conditions. An internist typically monitors chronic physical conditions, identifies acute diseases, provides family planning, provides counseling about wellness and disease prevention, etc.

The CLIA number of Licking Memorial Internal Medicine is 36D0327660 registered as a "physician office" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to Licking Memorial Internal Medicine to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

NPI

1730109166

Provider NameLICKING MEMORIAL INTERNAL MEDICINE (LICKING MEMORIAL PROFESSIONAL CORP)
Provider Location Address120 MCMILLEN DR NEWARK, OH 43055
Provider Mailing Address120 MCMILLEN DR NEWARK, OH 43055
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Other Organization NameLICKING MEMORIAL INTERNAL MEDICINE
Other Name TypeDoing Business As (3)
Enumeration Date07-20-2006
Last Update Date08-22-2020


Primary Taxonomy

Taxonomy Code207R00000X
ClassificationInternal Medicine
TypeAllopathic & Osteopathic Physicians
Taxonomy DescriptionA physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

Business Address

LICKING MEMORIAL INTERNAL MEDICINE
120 MCMILLEN DR
NEWARK, OH
ZIP 43055
Phone: (740) 348-4800
Fax: (740) 348-4801

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Mailing Address

LICKING MEMORIAL INTERNAL MEDICINE
120 MCMILLEN DR
NEWARK, OH
ZIP 43055
Phone: (740) 348-4800
Fax: (740) 348-4801



Authorized Official

Authorized Official Name ROBERT A. MONTAGNESE
Authorized Official TitleEXECUTIVE V.P
Authorized Official Phone(740) 348-4000

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for the NPI number 1730109166 is:

CLIA Number36D0327660
Facility TypePHYSICIAN OFFICE
Certificate TypeCertificate of Waiver

Group Taxonomy


193400000X SINGLE SPECIALTY GROUP - This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.

Other Providers at the same location


The following 9 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1023017860DR. MARK MITCHELL MD
Individual
Internal Medicine120 MCMILLEN DR
NEWARK, OH 43055
(740) 348-4814
1740289941DR. GERALD EHRSAM MD
Individual
Internal Medicine120 MCMILLEN DR
NEWARK, OH 43055
(740) 348-4806
1003005034 MISTI D. STAGGERS CNP
Individual
Clinical Nurse Specialist (Gerontology)120 MCMILLEN DR
NEWARK, OH 43055
(740) 348-7935
1174782775 DARIA J HOPKINS MD
Individual
Internal Medicine120 MCMILLEN DR
NEWARK, OH 43055
(220) 564-7935
1588007017MRS. NINA POLA HOURMOUZIS M.D.
Individual
Internal Medicine120 MCMILLEN DR
NEWARK, OH 43055
(220) 564-4806
1871813691DR. EVEN FENGYUAN WANG M.D.
Individual
Psychiatry & Neurology (Neurology)120 MCMILLEN DR
NEWARK, OH 43055
(220) 564-7985
1649290073LICKING MEMORIAL PROFESSIONAL CORP.
Organization
Internal Medicine (Geriatric Medicine)120 MCMILLEN DR
NEWARK, OH 43055
(740) 348-7935
1891051959 SARAH LAUREN LIM
Individual
Internal Medicine120 MCMILLEN DR
NEWRK, OH 43055
(220) 564-4800
1568857746 NISHI PATEL M.D.
Individual
Internal Medicine120 MCMILLEN DR
NEWARK, OH 43055
(220) 564-4814

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.