Provider Demographics
NPI:1295309029
Name:TRPP-ACO LLC
Entity type:Organization
Organization Name:TRPP-ACO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:LEGENDRE
Authorized Official - Last Name:BOUDREAUX
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:985-449-2585
Mailing Address - Street 1:602 N. ACADIA ROAD
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301
Mailing Address - Country:US
Mailing Address - Phone:985-493-4907
Mailing Address - Fax:985-493-2585
Practice Address - Street 1:602 N. ACADIA ROAD
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301
Practice Address - Country:US
Practice Address - Phone:985-493-4907
Practice Address - Fax:985-449-2585
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THIBODAUX REGIONAL HEALTH SYSTEM INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty