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LICKING MEMORIAL FAMILY PRACTICE HEBRON
NPI 1689690661
Family Medicine in Hebron, OH

Active since July 14, 2006CLIA 36D2124438 · Waiver
96 INTEGRITY DRIVE, H., HEBRON, OH 43025(740) 348-7930(740) 348-7931 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 Hebron NPPES

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

LICKING MEMORIAL FAMILY PRACTICE HEBRON (NPI 1689690661) is a healthcare organization registered as a family medicine in Hebron, Ohio and active in the NPI registry since July 2006. The organization holds a CLIA Waiver certificate valid through April 5, 2027 and lists Robert A. Montagnese, Executive V.p., as its authorized official.

NPPES Registry Identity

NPI1689690661
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameLICKING MEMORIAL PROFESSIONAL CORP.
Location Address96 INTEGRITY DRIVE, H.Hebron, OH 43025
Mailing Address96 Integrity DriveHebron, OH 43025 · (740) 348-7930 · Fax (740) 348-7931
Phone(740) 348-7930
Fax(740) 348-7931
Organization SubpartNo
Authorized OfficialRobert A. MontagneseExecutive V.p. · (740) 348-4000
Enumeration DateJuly 14, 2006
Last NPPES UpdateAugust 22, 2020
✔ NPI 1689690661 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.
96 INTEGRITY DRIVE, Hebron, OH 43025
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Other Names 1

Doing Business AsLicking Memorial Family Practice Hebron

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 36D2124438

Licking Memorial Family Practice Hebron · Hebron, OH
Active · expires Apr 5, 2027
CLIA Number36D2124438
Laboratory TypePhysician Office
Certificate Effective DateApril 6, 2025
Certificate Expiration DateApril 5, 2027
Laboratory DirectorChristopher M. Forbush
Laboratory Phone(220) 564-2100
Laboratory LocationLicking Memorial Family Practice Hebron96 Integrity Drive, Suite H, Hebron, OH 43025
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

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

HEBRON PHARMACY
Pharmacy (Community/Retail Pharmacy)
96 INTEGRITY DRIVE, SUITE D
HEBRON, OH 43025
Licking County (740) 928-3455

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 1689690661. It was assigned to this organization in the NPPES registry on July 14, 2006. The provider is doing business as Licking Memorial Family Practice Hebron.

Where is Licking Memorial Professional Corp. located?

Licking Memorial Professional Corp. is located at 96 Integrity Drive H., Hebron, OH 43025. The listed phone number is (740) 348-7930.

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 36D2124438) is associated with this NPI, valid through April 5, 2027. 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.