Provider Demographics
NPI:1942486535
Name:PEGASUS MEDICAL SERVICES, INC.
Entity Type:Organization
Organization Name:PEGASUS MEDICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:STAGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-322-3520
Mailing Address - Street 1:1136 OLIVER RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-5714
Mailing Address - Country:US
Mailing Address - Phone:318-322-3250
Mailing Address - Fax:318-322-3260
Practice Address - Street 1:1136 OLIVER RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5714
Practice Address - Country:US
Practice Address - Phone:318-322-3250
Practice Address - Fax:318-322-3260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA012235261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service