Provider Demographics
NPI:1265752430
Name:PEDAEGIS, LLC
Entity type:Organization
Organization Name:PEDAEGIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:COOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-975-9045
Mailing Address - Street 1:541 SHADOWS LN STE C
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-6531
Mailing Address - Country:US
Mailing Address - Phone:225-925-2000
Mailing Address - Fax:225-925-2095
Practice Address - Street 1:541 SHADOWS LN STE C
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-6531
Practice Address - Country:US
Practice Address - Phone:225-925-2000
Practice Address - Fax:225-925-2095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-10
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.012264261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care