Healthcare Provider Details

I. General information

NPI: 1497283733
Provider Name (Legal Business Name): NRMC PHYSICIAN IPA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2017
Last Update Date: 06/26/2020
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 KEYSER AVE
NATCHITOCHES LA
71457-6020
US

IV. Provider business mailing address

PO BOX 2475
NATCHITOCHES LA
71457-2475
US

V. Phone/Fax

Practice location:
  • Phone: 318-214-5770
  • Fax: 318-214-4625
Mailing address:
  • Phone: 318-214-5770
  • Fax: 318-214-4625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

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