Pelican Clinic LLC

Primary specialty

Adult Medicine PhysicianTaxonomy code 207QA0505X

License

27302 Issued in LA

Legal business name

PELICAN CLINIC LLC

Practice address

948 Cambridge Dr Ste 103B
La Place, LA 70068-3647

Phone

(985) 652-7717

Fax

(337) 896-6441

NPI assigned

Feb 10, 2012

Organization subpart

No

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

Authorized official

Name

Letha HaynesNPI 1104193176

Title

Owner

Phone

(954) 492-7150

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Letha Haynes

  • Allergy & Immunology Physician
  • La Place, LA
  • NPI 1104193176
  NPD Authorized official

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

{
    "created_epoch": "1328832000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682035200000",
    "number": "1740553569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "948 CAMBRIDGE DR STE 103B",
            "city": "LA PLACE",
            "state": "LA",
            "postal_code": "700683647",
            "telephone_number": "985-652-7717",
            "fax_number": "985-618-3611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "948 CAMBRIDGE DR STE 103B",
            "city": "LA PLACE",
            "state": "LA",
            "postal_code": "700683647",
            "telephone_number": "985-652-7717",
            "fax_number": "337-896-6441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PELICAN CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-10",
        "last_updated": "2023-04-21",
        "certification_date": "2023-04-21",
        "status": "A",
        "authorized_official_last_name": "HAYNES",
        "authorized_official_first_name": "LETHA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "954-492-7150"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": "LA",
            "license": "27302",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adult Medicine Physician in La Place, LA
• Providers in La Place, LA by specialty
• Adult Medicine Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2023; 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.