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NPI Code Detail

MEDICARE: THIBODAUX REGIONAL NETWORK DEVELOPMENT CORPORATION

MEDICARE: THIBODAUX REGIONAL NETWORK DEVELOPMENT CORPORATION
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
1207Q00000XFamily Medicine Physician
2207R00000XInternal Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1306125133
Entity Type Code : Organization
Provider Name (Legal Business Name) : THIBODAUX REGIONAL NETWORK DEVELOPMENT CORPORATION
Provider Business Mailing Address
First Line : PO BOX 5478
Second Line :
City : THIBODAUX
State : LA
Zip : 70302-5478
Country : US
Telephone Number : 985-493-4907
Fax Number : 985-449-2585
Provider Business Practice Location Address
First Line : 900 N CANAL BLVD
Second Line :
City : THIBODAUX
State : LA
Zip : 70301-8096
Country : US
Telephone Number : 985-493-4004
Fax Number : 985-493-4007
Authorized Official
Title or Position : CONTRACT MANAGER
Name : KIM LEGENDRE BOUDREAUX
Credential :
Telephone Number : 985-493-4907
Provider Enumeration Date : 08/10/2011
Last Update Date : 06/01/2026

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Directions to “THIBODAUX REGIONAL NETWORK DEVELOPMENT CORPORATION ” Practice Location

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