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Organization
THIBODAUX REGIONAL NETWORK DEVELOPMENT CORPORATION
Active
Organization
THIBODAUX REGIONAL NETWORK DEVELOPMENT CORPORATION
Active
Other names
Thibodaux Regional Wound Care & Limb Preservation Center
Organization subpart
No
Provider details
NPI number
Authorized official
KIM LEGENDRE BOUDREAUX (DIRECTOR OF CONTRACTING)
(985) 493-4907
Entity
Organization
Contact information
Practice address
290 BOWIE RD, STE A, THIBODAUX, LA 70301-6712
(985) 493-4990
Mailing address
602 N ACADIA RD, ACCOUNTING BLDG, THIBODAUX, LA 70301
(985) 493-4907
(985) 449-2585
Taxonomy
Speciality
Code
Description
License number
State
163WW0000X
Wound Care Registered Nurse
—
NULL
163WW0000X
Wound Care Registered Nurse
—
—
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
NULL
208100000X
Physical Medicine & Rehabilitation Physician
—
—
2083P0011X
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
Primary
—
NULL
2083P0011X
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
Primary
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
—
NULL
213ES0103X
Foot & Ankle Surgery Podiatrist
—
—
261QP1100X
Podiatric Clinic/Center
—
NULL
Other
Enumeration date
05/01/2024
Last updated
06/02/2025
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