Provider Demographics
NPI:1841627882
Name:CHURCH POINT PRIMARY CARE, LLC
Entity type:Organization
Organization Name:CHURCH POINT PRIMARY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GENE
Authorized Official - Middle Name:
Authorized Official - Last Name:MALBROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-684-1300
Mailing Address - Street 1:202 MURRELL ST
Mailing Address - Street 2:
Mailing Address - City:CHURCH POINT
Mailing Address - State:LA
Mailing Address - Zip Code:70525-2950
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:202 MURRELL ST
Practice Address - Street 2:
Practice Address - City:CHURCH POINT
Practice Address - State:LA
Practice Address - Zip Code:70525-2950
Practice Address - Country:US
Practice Address - Phone:337-684-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-06
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty