Provider Demographics
NPI:1720386402
Name:PELICAN ANESTHESIA LLC
Entity Type:Organization
Organization Name:PELICAN ANESTHESIA LLC
Other - Org Name:PELICAN ANESTHESIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MESSIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-437-5179
Mailing Address - Street 1:PO BOX 637757
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-7757
Mailing Address - Country:US
Mailing Address - Phone:800-437-5179
Mailing Address - Fax:239-278-9955
Practice Address - Street 1:6241 ARC WAY
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-1352
Practice Address - Country:US
Practice Address - Phone:800-437-5179
Practice Address - Fax:239-278-9955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-04
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG9008OtherBCBS OF FLORIDA
FL005487400Medicaid
FLEW477AMedicare PIN