Church Point Medical Clinic LLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

LA023828 Issued in LA

Legal business name

CHURCH POINT MEDICAL CLINIC LLC

Practice address

731 S Main St
Suite a
Church Point, LA 70525-4109

Phone

(337) 684-0911

Fax

(337) 684-0912

NPI assigned

Apr 20, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Marcelo Polanco, M.D.

Title

Owner

Phone

(337) 684-0911

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308614400000",
    "number": "1114144888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "731 S MAIN ST",
            "address_2": "SUITE A",
            "city": "CHURCH POINT",
            "state": "LA",
            "postal_code": "705254109",
            "telephone_number": "337-684-0911",
            "fax_number": "337-684-0912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "731 S MAIN ST",
            "address_2": "SUITE A",
            "city": "CHURCH POINT",
            "state": "LA",
            "postal_code": "705254109",
            "telephone_number": "337-684-0911",
            "fax_number": "337-684-0912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHURCH POINT MEDICAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-20",
        "last_updated": "2011-06-21",
        "status": "A",
        "authorized_official_last_name": "POLANCO",
        "authorized_official_first_name": "MARCELO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "337-684-0911",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "LA",
            "license": "LA023828",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1485438",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marjorie L Bourgeois, PT05/12/1946
• Braden Guidry, PT, LLC
• Martin Shawn Briggs, DDS
• Church Point Community Pharmacy
• Church Point Drug Inc (Church Point Pharmacy)
• Church Point Primary Care, LLC
• Jacob Michael Clement, MD
• CLHG-Acadian LLC (Church Point Medical Clinic by AMC)
• Consultants Home Care LLC
• Crystal G Deshotel

• Medical Specialty Clinic/Center in Church Point, LA
• Providers in Church Point, LA by specialty
• Medical Specialty Clinic/Center in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.