# THIBODAUX REGIONAL NETWORK DEVELOPMENT CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Thibodaux Regional Internal Medicine Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306125133
- **Authorized official:** KIM LEGENDRE BOUDREAUX (CONTRACT MANAGER)
- **Authorized official phone:** (985) 493-4907

## Contact information

- **Practice address:** 900 N CANAL BLVD, THIBODAUX, LA 70301-8096
- **Practice address phone:** (985) 493-4004
- **Practice address fax:** (985) 493-4007
- **Mailing address:** PO BOX 5478, THIBODAUX, LA 70302-5478
- **Mailing address phone:** (985) 493-4907
- **Mailing address fax:** (985) 449-2585

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/10/2011
- **Last updated:** 06/01/2026