Organization
THIBODAUX REGIONAL NETWORK DEVELOPMENT CORPORATION
Active
Organization
THIBODAUX REGIONAL NETWORK DEVELOPMENT CORPORATION
Active
Other names
Thibodaux Regional Neurology Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
KIM LEGENDRE BOUDREAUX (CONTRACT MANAGER)
(985) 493-4907
Entity
Organization
Contact information
Practice address
726 N. ACADIA RD, STE 2300, THIBODAUX, LA 70301-5078
(985) 493-3090
(985) 493-3091
Mailing address
602 N ACADIA RD, THIBODAUX, LA 70301-4823
(985) 493-3090
(985) 493-3091
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2376365
—
LA
Enumeration date
05/27/2014
Last updated
06/02/2025
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