Provider Demographics
NPI:1124284047
Name:SHELLY C. MCCORMICK MD LLC
Entity type:Organization
Organization Name:SHELLY C. MCCORMICK MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-398-7326
Mailing Address - Street 1:3811 WOODSIDE DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-2140
Mailing Address - Country:US
Mailing Address - Phone:318-376-3379
Mailing Address - Fax:
Practice Address - Street 1:3811 WOODSIDE DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-2140
Practice Address - Country:US
Practice Address - Phone:318-376-3379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty