Provider Demographics
NPI:1003484114
Name:NRMC PHYSICIAN IPA INC
Entity Type:Organization
Organization Name:NRMC PHYSICIAN IPA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFP
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:BRADFORD
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-214-4350
Mailing Address - Street 1:PO BOX 2475
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-2475
Mailing Address - Country:US
Mailing Address - Phone:318-214-5770
Mailing Address - Fax:318-214-4633
Practice Address - Street 1:211 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-6052
Practice Address - Country:US
Practice Address - Phone:318-238-3322
Practice Address - Fax:318-214-4633
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NRMC PHYSICIAN IPA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty