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General NPI Number Information
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NPI Number | 1184963613
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Entity Type | Organization
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Legal Business Name | THIBODAUX REGIONAL NETWORK DEVELOPMENT CORPORATION
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Dates
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Enumeration Date | 02/04/2013
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 604 N ACADIA RD STE 500
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City | THIBODAUX
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State | LA
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Zip | 70301-4743
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Country | US
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Telephone | 985-448-1216
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Fax | 985-446-8765
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Provider Business Mailing Address
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Address Line | PO BOX 5478
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City | THIBODAUX
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State | LA
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Zip | 70302-5478
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Country | US
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Telephone | 985-448-1216
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Fax | 985-446-8765
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Authorized Official
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Title or Position | DIRECTOR OF CONTRACTING
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Name | KIM LEGENDRE BOUDREAUX
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Credential |
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Telephone | 985-493-4907
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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