Provider Demographics
NPI:1578776050
Name:PULMONARY & DIGESTIVE CLINIC INC
Entity Type:Organization
Organization Name:PULMONARY & DIGESTIVE CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, MD
Authorized Official - Prefix:MR
Authorized Official - First Name:BOGDAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:NOWAKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-647-6900
Mailing Address - Street 1:P.O. BOX 400
Mailing Address - Street 2:
Mailing Address - City:BRITTANY
Mailing Address - State:LA
Mailing Address - Zip Code:70718-0400
Mailing Address - Country:US
Mailing Address - Phone:225-647-6900
Mailing Address - Fax:844-766-1659
Practice Address - Street 1:1429 E. HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737
Practice Address - Country:US
Practice Address - Phone:225-647-6900
Practice Address - Fax:844-766-1659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5C949Medicare ID - Type Unspecified