MMG LLC (NPI# 1407469166) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407469166 |
| Entity Type | Organization |
| Organization Name | MMG LLC |
| Other Organization Name | MOBILE MEDICAL GROUP |
| Practice Address |
80 Cottonwood Ct Ste 150 Eagle ID 83616-6577 |
| Mailing Address |
450 S 900 E Ste 100 Salt Lake City UT 84102-2983 |
| Practice Telephone | 2084562659 |
| Practice Fax Number | 2084540854 |
| Mailing Telephone | 8014566166 |
| Mailing Fax Number | 8015311949 |
| Enumeration Date | 2020-08-24 |
| Last Update Date | 2020-08-27 |
| Authorized Official Name | KENNETH E NORRIS (MANAGING PARTNER) |
| Authorized Official Telephone | 8014856166 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers |
| Other Name | Type Code |
|---|---|
| Mobile Medical Group | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699383794 | Mmg LLC | Nurse Practitioner | 2000 S Colorado Blvd Ste 110, Denver, CO 80222-7917 | 2020-07-15 |
| 1295392645 | Mmg LLC | Nurse Practitioner | 450 S 900 E Ste 175, Salt Lake City, UT 84102-2981 | 2019-05-21 |
| Street Address |
80 COTTONWOOD CT STE 150 |
| City | EAGLE |
| State | ID |
| Zip Code | 83616-6577 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730714049 | Care Medical Housecalls PC | Nurse Practitioner | 2040 E Holgate Ct, Eagle, ID 83616 | 2020-03-06 |
| 1629613823 | Counseling Solutions Center LLC | Marriage & Family Therapist | 2618 East Snocreek, Eagle, ID 83616 | 2019-11-12 |
| 1245726918 | Tracy Lyn Hagadorn | Midwife | 182 State Street, Eagle, ID 83616 | 2018-07-06 |
| 1861922627 | Nicholas A. Stelzner | Counselor | 2419 W. State St. Suite 8, Boise, ID 83616 | 2017-06-14 |
| 1184080210 | Gabriel Guerrero | Dermatology | 323 E Riverside Dr Ste 234, Eagle, ID 83616 | 2016-01-05 |
| 1376940668 | Cecilia Jo Hickam | Dental Hygienist | 1121 E. State Street, Suite - 102-d, Eagle, ID 83616 | 2014-12-02 |
| 1871912634 | Christine E Birch | Psychiatry & Neurology | 1032 S Bridgeway Pl Ste 110, Eagle, ID 83616 | 2014-04-09 |
| 1043552524 | Tori Croshaw | Social Worker | 372 S Eagle Rd Ste 190, Eagle, ID 83616 | 2013-03-21 |
| 1053650010 | Kellie Ann Northam | Nurse Practitioner | 192 West State Street, Eagle, ID 83616 | 2013-02-11 |
| 1437494457 | Mary Beth Roehling | Nurse Practitioner | 2040 E Hologate Ct, Eagle, ID 83616 | 2012-12-03 |
| Find all providers in zip 83616 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194244707 | Jessica Beth Long | Nurse Practitioner | 420 E State St Ste 135, Eagle, ID 83616-4898 | 2017-09-14 |
| 1104983881 | Rocky Mountain Health and Wellness LLC | Nurse Practitioner | 951 E Plaza Dr, Ste 110, Eagle, ID 83616-6566 | 2007-01-02 |
| 1619939451 | Katherine T Coate | Nurse Practitioner | 600 E State St, Ste 200, Eagle, ID 83616-6081 | 2006-04-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164039988 | Seth Thomas Six | Nurse Practitioner | 803 Mill Rd, Lewiston, ID 83501-0745 | 2020-09-25 |
| 1255947255 | Brandon Smith | Nurse Practitioner | 5067 Camden St, Chubbuck, ID 83202-3501 | 2020-09-16 |
| 1588288336 | Katina Ross | Nurse Practitioner | 11695 W Baserri Dr, Boise, ID 83709-1307 | 2020-06-07 |
| 1164043162 | Slavik Osipchuk | Nurse Practitioner | 2329 W Root Creek St, Meridian, ID 83646-4678 | 2020-04-30 |
| 1538708862 | Kay Dawn Martens | Nurse Practitioner | 334 E 200 S, Burley, ID 83318-5433 | 2020-01-03 |
| 1760025639 | Kimberly Watson | Nurse Practitioner | 3536 W Moon Lake St, Meridian, ID 83646-8304 | 2019-10-23 |
| 1932741212 | Kylie B Di Lulo | Nurse Practitioner | 1309 E Fall Ct, Boise, ID 83706-5076 | 2019-10-08 |
| 1225687759 | Hanna Percy | Nurse Practitioner | 1151 Hospital Way Ste 201, Pocatello, ID 83201 | 2019-09-07 |
| 1649824277 | Bryana Michel Hinck | Nurse Practitioner | 150 W Broderick Dr, Meridian, ID 83646-0009 | 2019-07-31 |
| 1982269973 | Patricia Conner | Nurse Practitioner | 775 Pole Line Rd W Ste 105&111, Twin Falls, ID 83301-5814 | 2019-05-06 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.