Healthcare Provider Details

I. General information

NPI: 1003484114
Provider Name (Legal Business Name): NRMC PHYSICIAN IPA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 MEDICAL DR
NATCHITOCHES LA
71457-6052
US

IV. Provider business mailing address

PO BOX 2475
NATCHITOCHES LA
71457-2475
US

V. Phone/Fax

Practice location:
  • Phone: 318-238-3322
  • 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 Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

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