# MONTGOMERY CLINIC LLC

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

## Provider details

- **NPI number:** 1730320946
- **Authorized official:** MARY I LONG MD (OFFICER)
- **Authorized official phone:** (318) 354-9348

## Contact information

- **Practice address:** 641 ROWENA ST, MONTGOMERY, LA 71454
- **Practice address phone:** (318) 354-9348
- **Mailing address:** 114 E 5TH ST, NATCHITOCHES, LA 71457-5725
- **Mailing address phone:** (318) 354-9348
- **Mailing address fax:** (318) 354-9269

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 022285 | LA | Yes |

## Other

- **Enumeration date:** 03/18/2009
- **Last updated:** 03/18/2009