Organization
THIBODAUX REGIONAL NETWORK DEVELOPMENT CORPORATION
Active
Other names
Thibodaux Regional Brain and Spine 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 2100, THIBODAUX, LA 70301-5078
(985) 447-2645
(985) 447-2604
Mailing address
PO BOX 5478, THIBODAUX, LA 70302-5478
(985) 447-2645
(985) 447-2604
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2131975
—
LA
Enumeration date
09/28/2010
Last updated
06/02/2025
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