LICKING MEMORIAL FAMILY PRACTICE-GRANVILLE
NPI 1043244965
Family Medicine in Granville, OH

Q: What is Licking Memorial Professional Corporation's specialty?

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

Active since July 10, 2006

1264 WEAVER DR, GRANVILLE, OH 43023(740) 348-1940(740) 348-1941 Get Directions Write a Review

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

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About Licking Memorial Family Practice-granville NPPES

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

LICKING MEMORIAL FAMILY PRACTICE-GRANVILLE (NPI 1043244965) is a healthcare organization registered as a family medicine in Granville, Ohio and active in the NPI registry since July 2006. The organization lists Robert A. Montagnese, Executive V.p., as its authorized official.

NPPES Registry Identity

NPI1043244965

Entity TypeOrganization

Primary Taxonomy207Q00000X

Legal Business NameLICKING MEMORIAL PROFESSIONAL CORPORATION

Location Address1264 WEAVER DRGranville, OH 43023-1257

Mailing Address1264 Weaver DrGranville, OH 43023-1257 · (740) 348-1940 · Fax (740) 348-1941

Phone(740) 348-1940

Fax(740) 348-1941

Organization SubpartNo

Authorized OfficialRobert A. MontagneseExecutive V.p. · (740) 348-4000

Enumeration DateJuly 10, 2006

Last NPPES UpdateAugust 22, 2020

✔ NPI 1043244965 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.

1264 WEAVER DR, Granville, OH 43023

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Other Names 1

Doing Business AsLicking Memorial Family Practice-granville

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

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 36D0327365

Licking Memorial Family Practice Granville · Granville, OH

Expired · Jul 31, 2026

CLIA Number36D0327365

Laboratory TypePhysician Office

Certificate Effective DateAugust 1, 2024

Certificate Expiration DateJuly 31, 2026

Laboratory DirectorNavin Muni

Laboratory Phone(220) 564-1960

Laboratory LocationLicking Memorial Family Practice Granville1264 Weaver Drive, Granville, OH 43023

CLIA data matches this NPI record on: Address Name

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 5

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

PRIT PATEL MD

Family Medicine