MARTY JAY MORTIMER


Address: 8501 Meadow Crk, Rockford, MI 49341-7524
Phone: 6162677884

MARTY JAY MORTIMER (NPI# 1689732810) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1689732810
Entity Type Individual
Full Name MARTY JAY MORTIMER
Credential PA-C
Practice Address 8501 Meadow Crk
Rockford
MI 49341-7524
Mailing Address 100 Michigan St Ne # Mc845
Grand Rapids
MI 49503-2560
Practice Telephone 6162677884
Mailing Telephone (616) 486-6790
Mailing Fax Number 6164866702
Enumeration Date 2006-12-04
Last Update Date 2017-08-07
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363A00000X Physician Assistant 5601006939 MI Physician Assistants & Advanced Practice Nursing Providers

Office Location

Street Address 8501 MEADOW CRK
City ROCKFORD
State MI
Zip Code 49341-7524

Providers in the same location

NPI Name Taxonomy Address Enumeration
1225032709 Philip E Henderson Internal Medicine 8501 Meadow Crk, Rockford, MI 49341-7524 2005-06-13
1740849611 Diane Marie Vancamp Pharmacist 8501 Meadow Crk, Rockford, MI 49341-7524 2019-06-13
1790299253 Stephanie Anne Vander Velde Physician Assistant 8501 Meadow Crk, Rockford, MI 49341-7524 2017-11-20
1477072700 Dulcie Yancharas Social Worker 8501 Meadow Crk, Rockford, MI 49341-7524 2017-09-19
1437692415 Deborah St Pierre Nurse Practitioner 8501 Meadow Crk, Rockford, MI 49341-7524 2016-11-23
1033569587 Amber Gall Nurse Practitioner 8501 Meadow Crk, Rockford, MI 49341-7524 2016-06-15
1528444833 Travis Ryan Guest Physician Assistant 8501 Meadow Crk, Rockford, MI 49341 2015-08-10
1235511668 Caesy Lewis Yarling Neuromusculoskeletal Medicine & OMM 8501 Meadow Crk, Rockford, MI 49341-7524 2015-06-22
1982086302 Matthew Bottke Family Medicine 8501 Meadow Crk, Rockford, MI 49341 2015-06-22
1346621356 Tristale Williams Social Worker 8501 Meadow Crk, Rockford, MI 49341-7524 2015-06-16
Find all providers in the same location

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1801451836 Heather Nash Social Worker 65 S. Main Street, Lower Level, Rockford, MI 49341 2019-05-06
1366967069 Caitlin Lebron Case Manager/Care Coordinator 8625 Wildcat Run Dr Ne, Rockford, MI 49341 2017-08-03
1366967077 Elite Nurse Staffing, LLC Nursing Care 3836 Windwood Drive, Ne, Rockford, MI 49341 2017-08-03
1336678747 Melissa Diane Maynard Behavior Technician 3361 36th St., Grand Rapids, MI 49341 2017-06-08
1376077453 Spectrum Health Primary Care Partners Internal Medicine 8501 Meadowcreek Dr, Rockford, MI 49341 2017-04-17
1871025254 Robin D Dine Behavior Technician 8636 Shaner Ave, Rockford, MI 49341 2017-04-03
1528503216 Miles Skalnek Pharmacist 511 10 Mile Road, Rockford, MI 49341 2017-01-04
1366801664 Lorri Ann Kelbel Massage Therapist 11591 Northland Drive Ne, Rockford, MI 49341 2016-02-15
1275872046 Eugene Louis Bonofiglo Dentist 4655- 14 Mile Rd Ne, Rockford, MI 49341 2013-02-13
1740539246 Erica Joyce Nichols Chiropractor 6769 Courtland Dr, Suite 100, Rockford, MI 49341 2012-08-30
Find all providers in zip 49341

Taxonomy Information

Taxonomy Code 363A00000X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Physician Assistant

Taxonomy Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1871063776 Amira Al-basha Physician Assistant 1639 N Alpine Rd Ste 380, Rockford, IL 61107-1440 2018-12-04
1578042982 Alyssa Margaret Vasylyuk Physician Assistant 2350 N Rockton Ave Fl 4, Rockford, IL 61103-3600 2018-08-08
1053778456 Jamie Anticevich Physician Assistant 6595 East State Street, Rockford, IL 61108-2542 2016-01-15
1437534666 Irene Dyer Physician Assistant 1560 Red Oak Ln, Rockford, IL 61107-2767 2015-07-29
1215250675 Krista R Mohamed Physician Assistant 1401 E. State St., Swedish American Hospital, Rockford, IL 61104-2315 2010-03-12
1629121009 Jason A. Kadar Physician Assistant 2902 Mcfarland Rd Ste 300, Rockford, IL 61107-6801 2007-01-19
1295805851 Kristin Lynn King-shank Physician Assistant 171 Dogwood Dr Ne, Rockford, MI 49341-7361 2006-11-09
1245263268 William John Stout Physician Assistant 1401 E State Street, Rockford, IL 61104 2006-07-10
1952356040 Saint Anthony Medical Center Physician Assistant 6830 Villagreen Vw, Rockford, IL 61107-5639 2006-05-24
1972552131 Andrea B Fulcomer Physician Assistant 2404 Charles St, Rockford, IL 61108-1602 2006-05-08
Find all providers in ROCKFORD

Competitor

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City ROCKFORD
Zip Code 49341

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Dataset Information

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.

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