| Pelican Pediatrics, Llc | |
|
911 W Main St Suite C Homer LA 71040-3300 | |
| (318) 927-3255 | |
| (318) 927-3257 |
| Full Name | Pelican Pediatrics, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 911 W Main St, Homer, Louisiana |
| Authorized Official Name and Position | Leslie Couvillon Brasher (OWNER, MANAGER) |
| Authorized Official Contact | 3189273255 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pelican Pediatrics, Llc 911 W Main St Suite C Homer LA 71040-3300 Ph: (318) 927-3255 | Pelican Pediatrics, Llc 911 W Main St Suite C Homer LA 71040-3300 Ph: (318) 927-3255 |
| NPI Number | 1184053340 |
|---|---|
| Provider Enumeration Date | 11/07/2013 |
| Last Update Date | 10/01/2014 |
| Medicare PECOS PAC ID | 5496982837 |
|---|---|
| Medicare Enrollment ID | O20131211000126 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184053340 | NPI | - | NPPES |
| 1325295 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | 2203781980 (Louisiana) | Primary |
| 363LP0200X | Nurse Practitioner - Pediatrics | APO5536 (Louisiana) | Secondary |
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