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:   
 
SSN:
(Last 4 Digits)