Pelican Clinic Llc | |
948 Cambridge Dr Ste 103b La Place LA 70068-3647 | |
(985) 652-7717 | |
(337) 896-6441 |
Full Name | Pelican Clinic Llc |
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Speciality | Family Medicine |
Location | 948 Cambridge Dr Ste 103b, La Place, Louisiana |
Authorized Official Name and Position | Letha Haynes (OWNER) |
Authorized Official Contact | 9544927150 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Pelican Clinic Llc 948 Cambridge Dr Ste 103b La Place LA 70068-3647 Ph: (985) 652-7717 | Pelican Clinic Llc 948 Cambridge Dr Ste 103b La Place LA 70068-3647 Ph: (985) 652-7717 |
NPI Number | 1740553569 |
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Provider Enumeration Date | 02/10/2012 |
Last Update Date | 04/21/2023 |
Medicare PECOS PAC ID | 9931367430 |
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Medicare Enrollment ID | O20120229000458 |
Identifier | Type | State | Issuer |
---|---|---|---|
1740553569 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207QA0505X | Family Medicine - Adult Medicine | 27302 (Louisiana) | Primary |
Provider Name | Jonathan J Roberts |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1881751667 PECOS PAC ID: 5496763690 Enrollment ID: I20060330000001 |
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