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Organization
THIBODAUX REGIONAL NETWORK DEVELOPMENT CORPORATION
Active
Organization
THIBODAUX REGIONAL NETWORK DEVELOPMENT CORPORATION
Active
Other names
Thibodaux Regional Women's Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
KIM LEGENDRE BOUDREAUX (DIRECTOR OF CONTRACTING)
(985) 493-4907
Entity
Organization
Contact information
Practice address
604 N ACADIA RD, STE 500, THIBODAUX, LA 70301-4743
(985) 448-1216
(985) 446-8765
Mailing address
PO BOX 5478, THIBODAUX, LA 70302-5478
(985) 448-1216
(985) 446-8765
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
NULL
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
207VG0400X
Gynecology Physician
—
NULL
207VG0400X
Gynecology Physician
—
—
207VX0000X
Obstetrics Physician
—
NULL
207VX0000X
Obstetrics Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2324845
—
LA
Enumeration date
02/04/2013
Last updated
06/02/2025
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