NPIMap

Organization Active NPI

Pelican Medical Clinic LLC

  • Family Medicine Physician
  • La Place, LA
National Provider Identifier
1205230760
Registry record updated Oct 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
RRT 421 Issued in LA
Legal business name
PELICAN MEDICAL CLINIC LLC
Practice address
7 Lagi St
La Place, LA 70068-8408
Phone
(504) 355-7453
NPI assigned
Oct 13, 2014
Last updated
Oct 13, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Letha Haynes, RRTNPI 1104193176
Title
Owner
Phone
(504) 355-7453

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X RRT 421 LA Primary

Addresses

Primary practice location

7 Lagi St
La Place, LA 70068-8408

Mailing address

54 Veterans Blvd
Donaldsonville, LA 70346-2450
Phone (504) 355-7453

National Provider Directory

National Provider Directory

Locations

54 Veterans Blvd
Donaldsonville, LA 70346
Phone (225) 717-0022

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1413158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413158400000",
    "number": "1205230760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "54 VETERANS BLVD",
            "city": "DONALDSONVILLE",
            "state": "LA",
            "postal_code": "703462450",
            "telephone_number": "504-355-7453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7 LAGI ST",
            "city": "LA PLACE",
            "state": "LA",
            "postal_code": "700688408",
            "telephone_number": "504-355-7453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PELICAN MEDICAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-13",
        "last_updated": "2014-10-13",
        "status": "A",
        "authorized_official_last_name": "HAYNES",
        "authorized_official_first_name": "LETHA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "504-355-7453",
        "authorized_official_credential": "RRT"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "RRT 421",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Place, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.