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General NPI Number Information
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NPI Number | 1295069490
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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 | 09/22/2009
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 608 N ACADIA RD FL 3
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City | THIBODAUX
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State | LA
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Zip | 70301-4847
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Country | US
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Telephone | 985-493-4346
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Fax | 985-449-2560
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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 | 985-493-4511
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Fax | 985-449-2535
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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 | 2085R0001X
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Taxonomy Name | Radiation Oncology 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 | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State |
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