Licking Memorial Professional Corp.
NPI 1235311358 · Geriatric Medicine (Family Medicine) Physician · Newark, OH
Licking Memorial Professional Corp. is a Geriatric Medicine (Family Medicine) Physician organization in Newark, OH (NPI 1235311358).
Provider details
- NPI number
- 1235311358
- Entity type
- Organization
- Primary specialty
- Geriatric Medicine (Family Medicine) PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Thomas Poulson, Cfo(740) 348-4110
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
18 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Other names (DBA / former)
- Doing business as
- Licking Memorial Geriatric Medicine at Autumn
Registry dates
- Enumerated
- 2007-11-30
- Last updated
- 2007-11-30
Frequently asked questions
- What is Licking Memorial Professional Corp.'s NPI number?
- Licking Memorial Professional Corp.'s National Provider Identifier (NPI) is 1235311358, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Licking Memorial Professional Corp.?
- Licking Memorial Professional Corp. is classified in the NPPES registry as Geriatric Medicine (Family Medicine) Physician (Allopathic & Osteopathic Physicians).
- Where is Licking Memorial Professional Corp. located?
- Licking Memorial Professional Corp.'s practice location on file with NPPES is 17 Forry St, Newark, OH 43055-4004.
- What is Licking Memorial Professional Corp.'s phone number?
- The practice phone number listed in the NPPES registry for Licking Memorial Professional Corp. is (740) 348-7935.
- Who is the authorized official for Licking Memorial Professional Corp.?
- The authorized official listed on Licking Memorial Professional Corp.'s NPPES record is Thomas Poulson, Cfo. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Licking Memorial Professional Corp.'s NPI active?
- Yes — Licking Memorial Professional Corp.'s NPI (1235311358) is active in the NPPES registry as of the last update on 2007-11-30.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.