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Organization

THIBODAUX REGIONAL NETWORK DEVELOPMENT CORPORATION

Active
Other names
Thibodaux Regional Multi-Specialty Clinic-Raceland
Organization subpart
No

Provider details

NPI number
Authorized official
KIM LEGENDRE BOUDREAUX (CONTRACT MANAGER)
(985) 493-4907
Entity
Organization

Contact information

Practice address
4560 HIGHWAY 1 STE 3, RACELAND, LA 70394-2779
(985) 435-4831
(985) 449-2513
Mailing address
602 N ACADIA RD, THIBODAUX, LA 70301-4823
(985) 251-4250
(985) 251-4251

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
207R00000X
Internal Medicine Physician
207RH0000X
Hematology (Internal Medicine) Physician
207RH0003X
Hematology & Oncology Physician
207RP1001X
Pulmonary Disease Physician
207T00000X
Neurological Surgery Physician
208000000X
Pediatrics Physician
2084N0400X
Neurology Physician
208800000X
Urology Physician
261QM1300X
Multi-Specialty Clinic/Center
Primary
363LF0000X
Family Nurse Practitioner

Other

Enumeration date
02/11/2021
Last updated
09/05/2023
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