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NPI Code Detail

MEDICARE: THIBODAUX REGIONAL URGENT CARE LLC

MEDICARE: THIBODAUX REGIONAL URGENT CARE LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QU0200XUrgent Care Clinic/Center

General Provider Information

NPI Number : 1154097996
Entity Type Code : Organization
Provider Name (Legal Business Name) : THIBODAUX REGIONAL URGENT CARE LLC
Provider Business Mailing Address
First Line : 602 N ACADIA RD
Second Line :
City : THIBODAUX
State : LA
Zip : 70301-4823
Country : US
Telephone Number : 985-493-4740
Fax Number : 985-446-5033
Provider Business Practice Location Address
First Line : 1411 SAINT CHARLES ST
Second Line :
City : HOUMA
State : LA
Zip : 70360-3964
Country : US
Telephone Number : 985-709-0136
Fax Number : 985-709-0527
Authorized Official
Title or Position : CONTRACT MANAGER
Name : KIM L BOUDREAUX
Credential : MBA
Telephone Number : 985-493-4907
Provider Enumeration Date : 08/20/2021
Last Update Date : 09/05/2023

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Directions to “THIBODAUX REGIONAL URGENT CARE LLC ” Practice Location

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