Organization
THIBODAUX REGIONAL NETWORK DEVELOPMENT CORPORATION
Active
Other names
Thibodaux Regional Network Development Corporation - Maternal Fetal
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) 493-4544
(985) 544-9253
Mailing address
PO BOX 5478, THIBODAUX, LA 70302-5478
(985) 493-4544
(985) 449-2535
Taxonomy
Speciality
Code
Description
License number
State
207VM0101X
Maternal & Fetal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1804410
—
LA
Enumeration date
09/16/2009
Last updated
09/05/2023
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