LICKING MEMORIAL PROFESSIONAL CORP NPI 1255365102

NPI Information

  • NPI: 1255365102
  • Provider Name: LICKING MEMORIAL PROFESSIONAL CORP
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • Doing Business As: LICKING MEMORIAL FAMILY PRACTICE JOHNSTOWN
  • CLIA Number: 36D0980226
  • Address: 151 WOODGATE DR
    JOHNSTOWN, OH
    ZIP 43031
  • Phone: (740) 348-1810

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NPI Details

LICKING MEMORIAL PROFESSIONAL CORP is a family medicine in Johnstown, OH. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. LICKING MEMORIAL PROFESSIONAL CORP NPI is 1255365102. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Licking Memorial Family Practice Johnstown.

The provider's business location address is:

151 WOODGATE DR
JOHNSTOWN, OH
ZIP 43031-198
Phone: (740) 348-1810
Fax: (740) 348-1811

The provider's authorized official is Robert Montagnese .
The authorized official title is Executive V.p and has the following contact phone number (740) 348-4000.

The CLIA number assigned to this NPI record is 36D0980226 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/10/2006 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily MedicineYes

What is NPI?

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This page was last updated on: 11/21/2025

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