Provider Demographics
NPI:1275535148
Name:THIBODAUX LASER AND SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:THIBODAUX LASER AND SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:ARCENEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-447-7246
Mailing Address - Street 1:1101 AUDUBON AVE
Mailing Address - Street 2:SUITE S4
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-4957
Mailing Address - Country:US
Mailing Address - Phone:985-447-5938
Mailing Address - Fax:985-448-1521
Practice Address - Street 1:1101 AUDUBON AVE
Practice Address - Street 2:SUITE S4
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4957
Practice Address - Country:US
Practice Address - Phone:985-447-5938
Practice Address - Fax:985-448-1521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CJ8872OtherRR MEDICARE
5CF38Medicare PIN