Organization
CHURCH POINT MEDICAL CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARCELO POLANCO M.D. (OWNER)
(337) 684-0911
Entity
Organization
Contact information
Practice address
731 S MAIN ST, SUITE A, CHURCH POINT, LA 70525-4109
(337) 684-0911
(337) 684-0912
Mailing address
731 S MAIN ST, SUITE A, CHURCH POINT, LA 70525-4109
(337) 684-0911
(337) 684-0912
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
LA023828
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1485438
—
LA
Enumeration date
04/20/2007
Last updated
06/21/2011
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