Provider Demographics
NPI:1154097996
Name:THIBODAUX REGIONAL URGENT CARE LLC
Entity Type:Organization
Organization Name:THIBODAUX REGIONAL URGENT CARE LLC
Other - Org Name:THIBODAUX REGIONAL URGENT CARE - HOUMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTRACT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOUDREAUX
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:985-493-4907
Mailing Address - Street 1:602 N ACADIA RD
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-4823
Mailing Address - Country:US
Mailing Address - Phone:985-493-4740
Mailing Address - Fax:985-446-5033
Practice Address - Street 1:1411 SAINT CHARLES ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-3964
Practice Address - Country:US
Practice Address - Phone:985-709-0136
Practice Address - Fax:985-709-0527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-20
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care