Healthcare Provider Details

I. General information

NPI: 1326262379
Provider Name (Legal Business Name): TRANSITIONS OBGYN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 01/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 DAVIS DR
THIBODAUX LA
70301-8020
US

IV. Provider business mailing address

PO BOX 5237
THIBODAUX LA
70302-5237
US

V. Phone/Fax

Practice location:
  • Phone: 985-803-0584
  • Fax: 985-449-0700
Mailing address:
  • Phone: 985-803-0584
  • Fax: 985-449-0700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number020707
License Number StateLA

VIII. Authorized Official

Name: DR. JUDITH C BLAISE
Title or Position: PRESIDENT
Credential: MD
Phone: 985-803-0584