# THIBODAUX REGIONAL NETWORK DEVELOPMENT CORPORATION

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

## Provider details

- **NPI number:** 1396162269
- **Authorized official:** KIM LEGENDRE BOUDREAUX (DIRECTOR OF CONTRACTINGS)
- **Authorized official phone:** (985) 493-4907

## Contact information

- **Practice address:** 114 HWY 403, PAINCOURTVILLE, LA 70391-0300
- **Practice address phone:** (985) 369-6070
- **Practice address fax:** (985) 369-3514
- **Mailing address:** PO BOX 5478, THIBODAUX, LA 70302-5478
- **Mailing address phone:** (985) 369-6070
- **Mailing address fax:** (985) 369-3514

## Taxonomy

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

## Other

- **Enumeration date:** 03/27/2014
- **Last updated:** 06/03/2025