Organization
THIBODAUX REGIONAL NETWORK DEVELOPMENT CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM LEGENDRE BOUDREAUX (DIRECTOR OF CONTRACTING)
(985) 493-4907
Entity
Organization
Contact information
Practice address
602 N ACADIA RD, THIBODAUX, LA 70301-4847
(985) 447-5500
(985) 446-5033
Mailing address
PO BOX 5478, THIBODAUX, LA 70302-5478
(985) 447-5500
(985) 446-5033
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
207P00000X
Emergency Medicine Physician
—
—
207VM0101X
Maternal & Fetal Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1948756
—
LA
Enumeration date
07/26/2006
Last updated
08/21/2023
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