Provider Demographics
NPI:1730633926
Name:PELICAN PRIMARY CARE LLC
Entity type:Organization
Organization Name:PELICAN PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:504-309-8135
Mailing Address - Street 1:3801 HOUMA BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-4165
Mailing Address - Country:US
Mailing Address - Phone:504-309-8135
Mailing Address - Fax:504-309-8156
Practice Address - Street 1:3801 HOUMA BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-4165
Practice Address - Country:US
Practice Address - Phone:504-309-8135
Practice Address - Fax:504-309-8156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-05
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)Group - Multi-Specialty