MEDICARE: PEDAEGIS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	MD.012264	LA

General Provider Information

NPI Number	:	1265752430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDAEGIS, LLC

Provider Business Mailing Address
First Line	:	541 SHADOWS LN STE C
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-6531
Country	:	US
Telephone Number	:	225-925-2000
Fax Number	:	225-925-2095

Provider Business Practice Location Address
First Line	:	541 SHADOWS LN STE C
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-6531
Country	:	US
Telephone Number	:	225-925-2000
Fax Number	:	225-925-2095

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MICHAEL JAMES COOGAN
Credential	:	M.D.
Telephone Number	:	225-975-9045

Provider Enumeration Date	:	06/10/2010
Last Update Date	:	04/26/2011

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