# CHURCH POINT MEDICAL CLINIC LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114144888
- **Authorized official:** DR. MARCELO POLANCO M.D. (OWNER)
- **Authorized official phone:** (337) 684-0911

## Contact information

- **Practice address:** 731 S MAIN ST, SUITE A, CHURCH POINT, LA 70525-4109
- **Practice address phone:** (337) 684-0911
- **Practice address fax:** (337) 684-0912
- **Mailing address:** 731 S MAIN ST, SUITE A, CHURCH POINT, LA 70525-4109
- **Mailing address phone:** (337) 684-0911
- **Mailing address fax:** (337) 684-0912

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | LA023828 | LA | Yes |

## Other

- **Enumeration date:** 04/20/2007
- **Last updated:** 06/21/2011