Healthcare Provider Details

I. General information

NPI: 1306233572
Provider Name (Legal Business Name): NRMC WALK-IN CLINIC VENTURES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2015
Last Update Date: 06/26/2020
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 KEYSER AVE SUITE E
NATCHITOCHES LA
71457-6037
US

IV. Provider business mailing address

PO BOX 2475
NATCHITOCHES LA
71457-2475
US

V. Phone/Fax

Practice location:
  • Phone: 318-238-5300
  • Fax: 318-238-5301
Mailing address:
  • Phone: 318-238-5300
  • Fax: 318-238-5301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number000000
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

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