Provider Demographics
NPI:1316984677
Name:NAGEM MEDICAL SPECIALTIES, LLC
Entity type:Organization
Organization Name:NAGEM MEDICAL SPECIALTIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHON
Authorized Official - Middle Name:
Authorized Official - Last Name:NAGEM
Authorized Official - Suffix:
Authorized Official - Credentials:P D
Authorized Official - Phone:337-474-2224
Mailing Address - Street 1:2058 E MCNEESE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70607-4830
Mailing Address - Country:US
Mailing Address - Phone:337-474-2224
Mailing Address - Fax:337-474-2646
Practice Address - Street 1:2058 E MCNEESE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70607-4830
Practice Address - Country:US
Practice Address - Phone:337-474-2224
Practice Address - Fax:337-474-2646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5356NU1835N0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835N0905XPharmacy Service ProvidersPharmacistNuclearGroup - Single Specialty