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Organization

THIBODAUX REGIONAL NETWORK DEVELOPMENT CORPORATION

Active
Other names
Thibodaux Regional Women's Clinic
Organization subpart
No

Provider details

NPI number
Authorized official
KIM LEGENDRE BOUDREAUX (DIRECTOR OF CONTRACTING)
(985) 493-4907
Entity
Organization

Contact information

Practice address
604 N ACADIA RD, STE 500, THIBODAUX, LA 70301-4743
(985) 448-1216
(985) 446-8765
Mailing address
PO BOX 5478, THIBODAUX, LA 70302-5478
(985) 448-1216
(985) 446-8765

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
207VG0400X
Gynecology Physician
207VX0000X
Obstetrics Physician

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2324845
LA
Enumeration date
02/04/2013
Last updated
06/02/2025
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