# LICKING MEMORIAL PROFESSIONAL CORP.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Licking Memorial Family Practice Licking Valley
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013935865
- **Authorized official:** ROBERT MONTAGNESE (EXECUTIVE V.P.)
- **Authorized official phone:** (740) 348-4000

## Contact information

- **Practice address:** 2181 W HIGH ST, NEWARK, OH 43055-8917
- **Practice address phone:** (740) 348-1720
- **Practice address fax:** (740) 348-1726
- **Mailing address:** 2181 W HIGH ST, NEWARK, OH 43055-8917
- **Mailing address phone:** (740) 348-1720
- **Mailing address fax:** (740) 348-1726

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/18/2006
- **Last updated:** 08/22/2020