Mt Morris Family Medicine LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MK051305 Issued in MI

Legal business name

MT MORRIS FAMILY MEDICINE LLC

Practice address

8434 N Saginaw Rd
Mount Morris, MI 48458-1190

Phone

(810) 686-1997

Fax

(810) 686-1820

NPI assigned

Nov 16, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Melodie A Knicely, M.D.

Title

Physician

Phone

(810) 686-1997

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1289865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289865600000",
    "number": "1154622595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8434 N SAGINAW RD",
            "city": "MOUNT MORRIS",
            "state": "MI",
            "postal_code": "484581190",
            "telephone_number": "810-686-1997",
            "fax_number": "810-686-1820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8434 N SAGINAW RD",
            "city": "MOUNT MORRIS",
            "state": "MI",
            "postal_code": "484581190",
            "telephone_number": "810-686-1997",
            "fax_number": "810-686-1820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MT MORRIS FAMILY MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-16",
        "last_updated": "2010-11-16",
        "status": "A",
        "authorized_official_last_name": "KNICELY",
        "authorized_official_first_name": "MELODIE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "810-686-1997",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "MK051305",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PIN",
            "identifier": "0802500611",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "448882310",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shakeda Mitchell
• Davonna Rochelle Monroe
• Faylena Morris
• Rosie Morris
• Taleah Moye
• Mt Morris Medical Group PLLC
• Mt Morris RX PLLC
• Sheandra Nance
• Sara Jean Nankervis, RN
• Newcombe Chiropractic PLLC

• Family Medicine Physician in Mount Morris, MI
• Providers in Mount Morris, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.