Organization
THIBODAUX REGIONAL NETWORK DEVELOPMENT CORPORATION
Active
Other names
Thibodaux Regional Internal Medicine Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
KIM LEGENDRE BOUDREAUX (CONTRACT MANAGER)
(985) 493-4907
Entity
Organization
Contact information
Practice address
400 N ACADIA RD, THIBODAUX, LA 70301-4856
(985) 493-4004
(985) 493-4007
Mailing address
PO BOX 5478, THIBODAUX, LA 70302-5478
(985) 493-4907
(985) 449-2585
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2403915
—
LA
Enumeration date
08/10/2011
Last updated
12/01/2025
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