Provider Demographics
NPI:1306233572
Name:NRMC WALK-IN CLINIC VENTURES, LLC
Entity type:Organization
Organization Name:NRMC WALK-IN CLINIC VENTURES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
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:318-238-5300
Mailing Address - Fax:318-238-5301
Practice Address - Street 1:740 KEYSER AVE
Practice Address - Street 2:SUITE E
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-6037
Practice Address - Country:US
Practice Address - Phone:318-238-5300
Practice Address - Fax:318-238-5301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-24
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA000000363L00000X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2418297Medicaid
LA2489445Medicaid