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General NPI Number Information
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NPI Number | 1851532964
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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 | 03/19/2009
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 604 N ACADIA RD STE 409
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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 | 985-447-5500
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Fax |
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Provider Business Mailing Address
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Address Line | 602 N. ACADIA RD CONTRACT MANAGEMENT DEPT.
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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 | 985-447-5500
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Fax |
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease 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 | 2080P0202X
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Taxonomy Name | Pediatric Cardiology 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 | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number |
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License Number State |
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