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LICKING MEMORIAL FAMILY PRACTICE LICKING VALLEY
NPI 1013935865
Family Medicine in Newark, OH

Active since July 18, 2006CLIA Certified · 3 labs
2181 W HIGH ST, NEWARK, OH 43055(740) 348-1720(740) 348-1726 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Licking Memorial Family Practice Licking Valley NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LICKING MEMORIAL FAMILY PRACTICE LICKING VALLEY (NPI 1013935865) is a healthcare organization registered as a family medicine in Newark, Ohio and active in the NPI registry since July 2006. The organization holds 3 active CLIA laboratory certificates and lists Robert Montagnese, Executive V.p., as its authorized official.

NPPES Registry Identity

NPI1013935865
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameLICKING MEMORIAL PROFESSIONAL CORP.
Location Address2181 W HIGH STNewark, OH 43055-8917
Mailing Address2181 W High StNewark, OH 43055-8917 · (740) 348-1720 · Fax (740) 348-1726
Phone(740) 348-1720
Fax(740) 348-1726
Organization SubpartNo
Authorized OfficialRobert MontagneseExecutive V.p. · (740) 348-4000
Enumeration DateJuly 18, 2006
Last NPPES UpdateAugust 22, 2020
✔ NPI 1013935865 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
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.
2181 W HIGH ST, Newark, OH 43055
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Other Names 1

Doing Business AsLicking Memorial Family Practice Licking Valley

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA 3

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 36D0957201

Licking Memorial Family Practice Licking Valley · Newark, OH
Active · expires May 29, 2027
CLIA Number36D0957201
Laboratory TypePhysician Office
Certificate Effective DateMay 30, 2025
Certificate Expiration DateMay 29, 2027
Laboratory DirectorAndrew C. Seipel
Laboratory Phone(740) 348-1720
Laboratory LocationLicking Memorial Family Practice Licking Valley2181 W High Street, Newark, OH 43055
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 36D2179016

Licking Memorial Professional Corp Fp Drpk2 · Newark, OH
Active · expires Feb 12, 2028
CLIA Number36D2179016
Laboratory TypePhysician Office
Certificate Effective DateFebruary 13, 2026
Certificate Expiration DateFebruary 12, 2028
Laboratory DirectorMarita Moore
Laboratory Phone(220) 564-4824
Laboratory LocationLicking Memorial Professional Corp Fp Drpk21272 W Main St, Ste 206 Building 2, Newark, OH 43055
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 36D0327657

Licking Memorial Family Practice · Newark, OH
Active · expires May 31, 2027
CLIA Number36D0327657
Laboratory TypePhysician Office
Certificate Effective DateJune 1, 2025
Certificate Expiration DateMay 31, 2027
Laboratory DirectorJames Desapri
Laboratory Phone(220) 564-1780
Laboratory LocationLicking Memorial Family Practice1970 Tamarack Road, Newark, OH 43055
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. DOUGLAS SCHRAM DO
Family Medicine
2181 W HIGH ST
NEWARK, OH 43055
Licking County (740) 348-1720
SARAH ELIZABETH CATHERINE WILLIAMS FNP-C
Nurse Practitioner (Family)
2181 W HIGH ST
NEWARK, OH 43055
Licking County (220) 564-1420
ANDREW C. SEIPEL MD
Family Medicine
2181 W HIGH ST
NEWARK, OH 43055
Licking County (220) 564-1720
SARAH DORSKY FNP-C
Nurse Practitioner (Family)
2181 W HIGH ST
NEWARK, OH 43055
Licking County (220) 564-1720

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Licking Memorial Professional Corp.'s NPI number?

The NPI number for Licking Memorial Professional Corp. is 1013935865. It was assigned to this organization in the NPPES registry on July 18, 2006. The provider is doing business as Licking Memorial Family Practice Licking Valley.

Where is Licking Memorial Professional Corp. located?

Licking Memorial Professional Corp. is located at 2181 W High St, Newark, OH 43055. The listed phone number is (740) 348-1720.

What is Licking Memorial Professional Corp.'s specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Licking Memorial Professional Corp. hold CLIA laboratory certificates?

Yes. 3 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Licking Memorial Professional Corp. was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.