| Pelican Medical Wellness And Cosmetic Center | |
|
6473 Highway 44 Ste 103 Gonzales LA 70737-8179 | |
| (225) 257-1040 | |
| (225) 257-1043 |
| Full Name | Pelican Medical Wellness And Cosmetic Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 6473 Highway 44 Ste 103, Gonzales, Louisiana |
| Authorized Official Name and Position | Mary Margaret Gautreau (MANAGING MEMBER) |
| Authorized Official Contact | 2252571040 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pelican Medical Wellness And Cosmetic Center 40230 Pelican Point Pkwy Gonzales LA 70737-8511 Ph: (225) 257-1040 | Pelican Medical Wellness And Cosmetic Center 6473 Highway 44 Ste 103 Gonzales LA 70737-8179 Ph: (225) 257-1040 |
| NPI Number | 1356997399 |
|---|---|
| Provider Enumeration Date | 08/15/2019 |
| Last Update Date | 08/19/2021 |
| Medicare PECOS PAC ID | 9335570217 |
|---|---|
| Medicare Enrollment ID | O20200508001080 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356997399 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Mary M Gautreau |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1073664009 PECOS PAC ID: 3476782772 Enrollment ID: I20140304001634 |
| Provider Name | Sarah E Lemoine |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669028429 PECOS PAC ID: 1951711001 Enrollment ID: I20201102000941 |
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