Organization
THIBODAUX REGIONAL NETWORK DEVELOPMENT CORPORATION
Active
Other names
Thibodaux Regional Radiology
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, RADIOLOGY DEPT., THIBODAUX, LA 70301-4847
(985) 447-5500
Mailing address
PO BOX 5478, THIBODAUX, LA 70302-5478
(985) 447-5500
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1948756
—
LA
Enumeration date
02/22/2006
Last updated
09/05/2023
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