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Organization
THIBODAUX REGIONAL NETWORK DEVELOPMENT CORPORATION
Active
Organization
THIBODAUX REGIONAL NETWORK DEVELOPMENT CORPORATION
Active
Other names
Thibodaux Regional Internal Medicine Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
KIM LEGENDRE BOUDREAUX (CONTRACT MANAGER)
(985) 493-4907
Entity
Organization
Contact information
Practice address
900 N CANAL BLVD, THIBODAUX, LA 70301-8096
(985) 493-4004
(985) 493-4007
Mailing address
PO BOX 5478, THIBODAUX, LA 70302-5478
(985) 493-4907
(985) 449-2585
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
NULL
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
08/10/2011
Last updated
06/01/2026
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