Provider Demographics
NPI:1457474900
Name:LIMA MEMORIAL PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:LIMA MEMORIAL PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF LMP
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:UTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-998-4668
Mailing Address - Street 1:1001 BELLEFONTAINE AVE
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-2800
Mailing Address - Country:US
Mailing Address - Phone:419-998-4575
Mailing Address - Fax:419-998-4586
Practice Address - Street 1:1001 BELLEFONTAINE AVE
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-2800
Practice Address - Country:US
Practice Address - Phone:419-998-4575
Practice Address - Fax:419-998-4586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9311764Medicare PIN
OH9311765Medicare PIN
OH9311768Medicare PIN
OH9311769Medicare PIN
OH9346516Medicare PIN
OH9311761Medicare PIN
OH9311763Medicare PIN
OH9346514Medicare PIN
OH9346519Medicare PIN
OH6152110001Medicare NSC
OH9346512Medicare PIN
OH9346518Medicare PIN
OH9311767Medicare PIN
OH9346517Medicare PIN
OH9311762Medicare PIN
OH9346515Medicare PIN