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General NPI Number Information
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NPI Number | 1578360327
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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 | 02/28/2025
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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 207
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City | THIBODAUX
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State | LA
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Zip | 70301-4897
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Country | US
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Telephone | 985-446-1763
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Fax | 985-446-9813
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Provider Business Mailing Address
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Address Line | PO BOX 669400
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City | DALLAS
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State | TX
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Zip | 75266-9490
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Country | US
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Telephone | 985-493-4907
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Fax | 985-449-2585
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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 | MBA
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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 | 2086S0129X
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Taxonomy Name | Vascular Surgery 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 | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery 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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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