1235159674 NPI number — LICKING MEMORIAL PROFESSIONAL CORP.

Table of content: MS. JODIE LYNN KNIGHTEN LMP (NPI 1932349743)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235159674 NPI number — LICKING MEMORIAL PROFESSIONAL CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LICKING MEMORIAL PROFESSIONAL CORP.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LICKING MEMORIAL WOMENS HEALTH PATASKALA
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235159674
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 HEALTHY PL
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
PATASKALA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43062-7067
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-348-1920
Provider Business Mailing Address Fax Number:
740-348-1921

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 HEALTHY PL
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
PATASKALA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43062-7067
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-348-1920
Provider Business Practice Location Address Fax Number:
740-348-1921
Provider Enumeration Date:
07/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MONTAGENSE
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
EXECUTIVE V.P.
Authorized Official Telephone Number:
740-348-4000

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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