NPIMap

Organization Active NPI

Pelican Physician Services, LLC

  • Emergency Medical Services (Emergency Medicine) Physician
  • Slidell, LA
National Provider Identifier
1851609978
Registry record updated Jul 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X
License
06512R Issued in LA
Legal business name
PELICAN PHYSICIAN SERVICES, LLC
Practice address
2375 Gause Blvd E
Slidell, LA 70461-4142
Phone
(985) 645-9000
Fax
(985) 645-0359
NPI assigned
Sep 23, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2014

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

Authorized official

Name
Dr. Kumar Kishore Amaraneni, M.D
Title
Owner/Registered Agent
Phone
(985) 645-9000

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medical Services (Emergency Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207PE0004X 06512R LA Primary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 019740 LA
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 025659 LA
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X 025659 LA

Addresses

Primary practice location

2375 Gause Blvd E
Slidell, LA 70461-4142

Mailing address

2375 Gause Blvd E
Slidell, LA 70461-4142
Phone (985) 645-9000

Other identifiers 1

IdentifierTypeStateIssuer
1442119MedicaidLA

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1285200000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404864000000",
    "number": "1851609978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2375 GAUSE BLVD E",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704614142",
            "telephone_number": "985-645-9000",
            "fax_number": "985-645-0359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2375 GAUSE BLVD E",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704614142",
            "telephone_number": "985-645-9000",
            "fax_number": "985-645-0359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PELICAN PHYSICIAN SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-23",
        "last_updated": "2014-07-09",
        "status": "A",
        "authorized_official_last_name": "AMARANENI",
        "authorized_official_first_name": "KUMAR",
        "authorized_official_middle_name": "KISHORE",
        "authorized_official_title_or_position": "OWNER/REGISTERED AGENT",
        "authorized_official_telephone_number": "985-645-9000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "LA",
            "license": "06512R",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "019740",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "LA",
            "license": "025659",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "LA",
            "license": "025659",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1442119",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Slidell, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.