Healthcare Provider Details

I. General information

NPI: 1962111468
Provider Name (Legal Business Name): NRMC PHYSICIAN IPA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2022
Last Update Date: 11/23/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

647 BIENVILLE CIR
NATCHITOCHES LA
71457-5744
US

IV. Provider business mailing address

PO BOX 2475
NATCHITOCHES LA
71457-2475
US

V. Phone/Fax

Practice location:
  • Phone: 318-214-5770
  • Fax: 318-214-4633
Mailing address:
  • Phone: 318-214-5770
  • Fax: 318-214-4633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM BRADFORD MCCORMICK
Title or Position: CFO
Credential:
Phone: 318-214-4350