LICKING MEMORIAL PROFESSIONAL CORP. NPI 1497771521

NPI Information

  • NPI: 1497771521
  • Provider Name: LICKING MEMORIAL PROFESSIONAL CORP.
  • Classification: Pediatrics - 208000000X
  • Entity Type: Organization
  • Doing Business As: LICKING MEMORIAL PEDIATRICS-UTICA
  • CLIA Number: 36D2319575
  • Address: 240 N. MAIN ST
    UTICA, OH
    ZIP 43080
  • Phone: (740) 348-1740

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NPI Details

LICKING MEMORIAL PROFESSIONAL CORP. is a pediatrics in Utica, OH. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. LICKING MEMORIAL PROFESSIONAL CORP. NPI is 1497771521. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Licking Memorial Pediatrics-utica.

The provider's business location address is:

240 N. MAIN ST
UTICA, OH
ZIP 43080
Phone: (740) 348-1740
Fax: (740) 348-1741

The provider's authorized official is Robert A. 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 36D2319575 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/14/2006 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
1208000000XPediatricsYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
12143906MEDICAIDOHIO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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