Licking Memorial Professional Corp

NPI #1851325526 in Pataskala, Ohio

Provider Information

NPI Number: 1851325526
Entity Type: Organization
Organization Name: Licking Memorial Professional Corp
Primary Specialty: Family Medicine
Enumeration Date: Jul 10, 2006
Last Updated: Aug 22, 2020

Practice Location

Address: 1 HEALTHY PL
Address 2: SUITE 101
City: Pataskala
State: Ohio
ZIP Code: 43062-7067
Phone: (740) 348-1900

Authorized Official

Name: ROBERT A. MONTAGNESE
Title: EXECUTIVE V.P.
Phone: (740) 348-4000

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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