Verifying a Medical/Professional Staff Member
Welcome to Licking Memorial Hospital's Website for the Verification of Medical Staff Membership and/or Clinical Privileges.
This is the first screen to compose a verification letter. Enter the name of the practitioner and click on "Submit Query".
If the provider you are searching for is not on the web, please fax your request and a signed release to the office of the Chief of Staff at (220) 564-4012. If you require further information or have any questions, please contact the Medical Staff office at (220) 564-4010.
Last Name:
*
First Name:
Specialty:
----- Any Specialty -----
ANP
Addiction Medicine
Administration
Administration/Occupational Medicine
Adult Pulmonology & Critical Care Medicine
Allergist
Allergy and Immunology
Anesthesiology
Audiology
Behavioral Health
Cardiology
Certified Nurse Midwife
Certified Nurse Practitioner
Certified Nurse Practitioner
Certified Ophthalmic Technician
Certified Registered Nurse Anesthetist
Clinical Nurse Specialist
Dental assistant
Dentistry
Dermatology
Emergency Medicine
Endocrinology
Family Practice
Gastroenterology
General Surgery
General Vascular Surgery
Geriatric Medicine
Gynecology
Hematology/Oncology
Hospital Medicine
Infectious Disease
Internal Medicine
Lab Technician
Licensed Independent Social Worker
Licensed Professional Clinical Counselor
Medicaid Medical
Medicaid Obstretical
Medicaid Obstretical Medical
Medicaid Pediatric Medical
Medicaid Pediatric Psychiatric
Medicaid Pediatric Surgical
Medicaid Psychiatric
Medicaid Surgical
Medical
Medical Assistant
Medicare Medical
Medicare Obstetrical
Medicare Psychiatric
Medicare Surgical
Neonatal Nurse Practitioner
Neonatal Nurse Specialist
Neonatology
Nephrology
Neurology
Neurosurgery
Newborn Any Baby Adm To Nur
Nurse
Obstetrical Medical
Obstetrics
Obstetrics & Gynecology
Occupational Medicine
Oncology Nurse Practitioner
Ophthalmology
Opthalmology
Oral Maxillofacial Surgery
Oral Maxillofacial Surgery(+Dent)
Orthopedic Surgery
Orthopedics
Orthotics & Prosthetics
Otolaryngology
PICU Staff Nurse
Pain Management
Palliative Medicine
Pathology
Pediatric Medical 14 and Under
Pediatric Nurse Practitioner
Pediatric Psychiatric
Pediatric Surgical 14 and Under
Pediatrics
Physical Medicine
Physician Assistant
Physician Private Nurse
Plastic Surgery
Podiatry
Psychiatry
Psychology
Radiation Oncology
Radiology
Registered Nurse First Assistant
Rheumatology
Rounding Assistant
Scrub Technician
Sleep Medicine
Surgical
Surgical RN
Surgical Technician
Surgical Technologist
Surgical Technologist/First Assistant
Telemedicine Neurology
Telemedicine Neurology
Telemedicine Radiology
Telemedicine Vascular Ultrasound Interpretation
Telemedicine Vascular Ultrasound Interpretation
Transport Clinician
Unknown
Urology
Vascular Surgery
Vascular/General Surgery
SSN:
(Last 4 Digits)
*