David Mortlock (NPI# 1861691552, PAC ID# 1658495098) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is FAMILY PRACTICE.
| Nation Provider ID (NPI) | 1861691552 |
| PAC ID by PECOS | 1658495098 |
| Professional Enrollment ID | I20100907001083 |
| Full Name | David Mortlock |
| Organization Legal Name | CENTRA MEDICAL GROUP, LLC |
| Address |
291 Mcbride Ln Gretna VA 24557-2773 |
| Phone Number | 4346561274 |
| Gender | M |
| Graduation Year | 2006 |
| Primary Specialty | FAMILY PRACTICE |
| Group Practice PAC ID | 4789606088 |
| Number of Group Practice Members | 461 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 490021 | CENTRA |
| Address | Phone | Organization |
|---|---|---|
| 291 Mcbride Ln, Gretna, VA 24557-2773 | 4346561274 | CENTRA MEDICAL GROUP, LLC |
| Organization Legal Name | CENTRA MEDICAL GROUP, LLC |
| Physicians | 53 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Laurie R Taylor | Nurse Practitioner | Centra Medical Group, LLC | 130 Enterprise Dr, Danville, VA 24540-4070 |
| Amie E Kennedy | Certified Nurse Midwife | Centra Medical Group, LLC | 2007 Graves Mill Rd, Forest, VA 24551-2656 |
| Assaad M Mounzer | Urology | Centra Medical Group, LLC | 800 Oak St, Farmville, VA 23901-1199 |
| Erin M Baird | Certified Nurse Midwife | Centra Medical Group, LLC | 2007 Graves Mill Rd, Forest, VA 24551-2656 |
| Matthew A Johnson | Family Practice | Centra Medical Group, LLC | 915 S Main St, Farmville, VA 23901-2211 |
| Terry Lea Yeager | Certified Registered Nurse Anesthetist | Centra Medical Group, LLC | 1613 Oakwood St, Suite 101, Bedford, VA 24523-1213 |
| Michelle Adams | Nurse Practitioner | Centra Medical Group, LLC | 800 Oak St, Farmville, VA 23901-1199 |
| Tracy J Langebeck | Nurse Practitioner | Centra Medical Group, LLC | 1901 Tate Springs Rd, Lynchburg, VA 24501-1109 |
| Arthur Frank Selden | Clinical Psychologist | Centra Medical Group, LLC | 1901 Tate Springs Rd, Lynchburg, VA 24501-1109 |
| Benjamin Taylor Colston | Physician Assistant | Centra Medical Group, LLC | 1911 Thomson Dr, Lynchburg, VA 24501-1008 |
| Street Address |
291 MCBRIDE LN |
| City | GRETNA |
| State | VA |
| Zip | 24557-2773 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Sharon P Hawout | Certified Nurse Midwife (cnm) | Centra Medical Group LLC | 291 Mcbride Ln, Gretna, VA 24557-2773 |
| Zaki Mustafa Elsarrag | Emergency Medicine | Centra Medical Group LLC | 291 Mcbride Ln, Gretna, VA 24557-2773 |
| Sheree W Marilla | Nurse Practitioner | Centra Medical Group LLC | 291 Mcbride Ln, Gretna, VA 24557-2773 |
| Melissa R Coleman | Nurse Practitioner | Centra Medical Group LLC | 291 Mcbride Ln, Gretna, VA 24557-2773 |
| Anne M Saunier | Nurse Practitioner | Centra Medical Group LLC | 291 Mcbride Ln, Gretna, VA 24557-2773 |
| Brenden M Burkholder | Internal Medicine | Centra Medical Group LLC | 291 Mcbride Ln, Gretna, VA 24557-2773 |
| Jonathan Roeber | Physical Therapy | Centra Outpatient Rehabilitation Services LLC | 291 Mcbride Ln, Gretna, VA 24557-2773 |
| Tashan Duff | Physical Therapy | Centra Outpatient Rehabilitation Services LLC | 291 Mcbride Ln, Gretna, VA 24557-2773 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Bonnie C Daniel | Nurse Practitioner | Danville Physician Practices LLC | 305 N Main St, Gretna, VA 24557-4176 |
| John G Daniel | Family Practice | Danville Physician Practices LLC | 305 N Main St, Gretna, VA 24557-4176 |
| City | GRETNA |
| Zip Code | 24557 |
| Specialty | FAMILY PRACTICE |
| City + Specialty | GRETNA + FAMILY PRACTICE |
Please comment or provide details below to improve the information on David Mortlock.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.