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General NPI Number Information
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NPI Number | 1497348379
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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 | 02/11/2021
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Last Update Date | 09/05/2023
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Provider Practice Location Address
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Address Line | 4560 HIGHWAY 1 STE 3
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City | RACELAND
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State | LA
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Zip | 70394-2779
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Country | US
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Telephone | 985-435-4831
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Fax | 985-449-2513
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Provider Business Mailing Address
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Address Line | 602 N ACADIA RD
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City | THIBODAUX
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State | LA
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Zip | 70301-4823
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Country | US
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Telephone | 985-251-4250
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Fax | 985-251-4251
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Authorized Official
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Title or Position | CONTRACT MANAGER
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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 | 207Q00000X
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Taxonomy Name | Family Medicine 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 | 207R00000X
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Taxonomy Name | Internal Medicine 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 | 207RH0000X
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Taxonomy Name | Hematology (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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Taxonomy #7
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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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Taxonomy #8
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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