Provider Demographics
NPI:1790275279
Name:NRMC PHYSICIAN IPA INC
Entity Type:Organization
Organization Name:NRMC PHYSICIAN IPA INC
Other - Org Name:NRMC PULMONOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
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:318-214-4623
Practice Address - Street 1:601 KEYSER AVE
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-6020
Practice Address - Country:US
Practice Address - Phone:318-214-5770
Practice Address - Fax:318-214-4623
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NRMC PHYSICIAN IPA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-10
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty