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LICKING MEMORIAL FAMILY PRACTICE JOHNSTOWN
NPI 1255365102
Family Medicine in Johnstown, OH

Active since July 10, 2006CLIA 36D0980226 · Waiver
151 WOODGATE DR, JOHNSTOWN, OH 43031(740) 348-1810(740) 348-1811 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Licking Memorial Family Practice Johnstown NPPES

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

LICKING MEMORIAL FAMILY PRACTICE JOHNSTOWN (NPI 1255365102) is a healthcare organization registered as a family medicine in Johnstown, Ohio and active in the NPI registry since July 2006. The organization holds a CLIA Waiver certificate valid through April 30, 2028 and lists Robert Montagnese, Executive V.p, as its authorized official.

NPPES Registry Identity

NPI1255365102
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameLICKING MEMORIAL PROFESSIONAL CORP
Location Address151 WOODGATE DRJohnstown, OH 43031-1198
Mailing Address151 Woodgate DrJohnstown, OH 43031-1198 · (740) 348-1810 · Fax (740) 348-1811
Phone(740) 348-1810
Fax(740) 348-1811
Organization SubpartNo
Authorized OfficialRobert MontagneseExecutive V.p · (740) 348-4000
Enumeration DateJuly 10, 2006
Last NPPES UpdateAugust 22, 2020
✔ NPI 1255365102 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.
151 WOODGATE DR, Johnstown, OH 43031
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Other Names 1

Doing Business AsLicking Memorial Family Practice Johnstown

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 36D0980226

Licking Memorial Family Practice Johnstown · Johnstown, OH
Active · expires Apr 30, 2028
CLIA Number36D0980226
Laboratory TypePhysician Office
Certificate Effective DateMay 1, 2026
Certificate Expiration DateApril 30, 2028
Laboratory DirectorElizabeth Mcintosh
Laboratory Phone(740) 348-1810
Laboratory LocationLicking Memorial Family Practice Johnstown151 Woodgate Drive, Johnstown, OH 43031
CLIA data matches this NPI record on: Address Name Phone
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.

ELIZABETH WEI MCINTOSH M.D.
Family Medicine
151 WOODGATE DR
JOHNSTOWN, OH 43031
Licking County (220) 564-1810
DARCI HARTSHORN APRN-CNP
Nurse Practitioner (Family)
151 WOODGATE DR
JOHNSTOWN, OH 43031
Licking County (220) 564-1810
SUELLYWN STEWART MD
Family Medicine
151 WOODGATE DR
JOHNSTOWN, OH 43031
Licking County (220) 564-1810
TIFFANY NICOLE CORBEAN MD
Family Medicine
151 WOODGATE DR
JOHNSTOWN, OH 43031
Licking County (220) 564-1810

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 1255365102. It was assigned to this organization in the NPPES registry on July 10, 2006. The provider is doing business as Licking Memorial Family Practice Johnstown.

Where is Licking Memorial Professional Corp located?

Licking Memorial Professional Corp is located at 151 Woodgate Dr, Johnstown, OH 43031. The listed phone number is (740) 348-1810.

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 a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 36D0980226) is associated with this NPI, valid through April 30, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

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.