Provider Demographics
NPI:1649242611
Name:C SCOTT BOAGNI MD APMC
Entity Type:Organization
Organization Name:C SCOTT BOAGNI MD APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:C
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BOAGNI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-942-7155
Mailing Address - Street 1:331 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-6137
Mailing Address - Country:US
Mailing Address - Phone:337-942-7155
Mailing Address - Fax:337-942-2801
Practice Address - Street 1:331 S MAIN ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6137
Practice Address - Country:US
Practice Address - Phone:337-942-7155
Practice Address - Fax:337-942-2801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-03
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAO20814207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1657506Medicaid
LACK8600OtherMEDICARE RAILROAD
F99458Medicare UPIN
LA5CE12Medicare PIN