# LICKING MEMORIAL PROFESSIONAL CORP.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Licking Memorial Womens Health Pataskala
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235159674
- **Authorized official:** ROBERT A. MONTAGENSE (EXECUTIVE V.P.)
- **Authorized official phone:** (740) 348-4000

## Contact information

- **Practice address:** 1 HEALTHY PL, SUITE 103, PATASKALA, OH 43062-7067
- **Practice address phone:** (740) 348-1920
- **Practice address fax:** (740) 348-1921
- **Mailing address:** 1 HEALTHY PL, SUITE 103, PATASKALA, OH 43062-7067
- **Mailing address phone:** (740) 348-1920
- **Mailing address fax:** (740) 348-1921

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/20/2006
- **Last updated:** 08/22/2020