MEDICARE: LOUIS H MCCORMICK MD, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	04661R	LA
2	261QP2300X	Primary Care Clinic/Center	04661R	LA

General Provider Information

NPI Number	:	1154503241
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOUIS H MCCORMICK MD, LLC

Provider Business Mailing Address
First Line	:	606 HAIFLEIGH ST
Second Line	:
City	:	FRANKLIN
State	:	LA
Zip	:	70538-3731
Country	:	US
Telephone Number	:	337-828-4440
Fax Number	:

Provider Business Practice Location Address
First Line	:	606 HAIFLEIGH ST
Second Line	:
City	:	FRANKLIN
State	:	LA
Zip	:	70538-3731
Country	:	US
Telephone Number	:	337-828-4440
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LOUIS H MCCORMICK
Credential	:	MD
Telephone Number	:	337-828-4440

Provider Enumeration Date	:	11/29/2007
Last Update Date	:	12/03/2007

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