Provider Demographics
NPI:1295392645
Name:MMG LLC
Entity Type:Organization
Organization Name:MMG LLC
Other - Org Name:MOBILE MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-485-6166
Mailing Address - Street 1:746 E WINCHESTER ST STE 230B
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-8528
Mailing Address - Country:US
Mailing Address - Phone:801-456-2333
Mailing Address - Fax:801-456-2330
Practice Address - Street 1:746 E WINCHESTER ST STE 230B
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-8528
Practice Address - Country:US
Practice Address - Phone:801-456-2333
Practice Address - Fax:801-456-2330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-21
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty