Healthcare Provider Details

I. General information

NPI: 1316129513
Provider Name (Legal Business Name): THIBODAUX URGENT CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 N CANAL BLVD
THIBODAUX LA
70301-2996
US

IV. Provider business mailing address

3510 N CAUSEWAY BLVD SUITE 110
METAIRIE LA
70002-3531
US

V. Phone/Fax

Practice location:
  • Phone: 985-446-5210
  • Fax: 985-446-8327
Mailing address:
  • Phone: 504-831-3112
  • Fax: 504-831-3778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. KEITH LEBLANC
Title or Position: CEO
Credential:
Phone: 504-831-3112