Provider Demographics
NPI:1396162269
Name:THIBODAUX REGIONAL NETWORK DEVELOPMENT CORPORATION
Entity type:Organization
Organization Name:THIBODAUX REGIONAL NETWORK DEVELOPMENT CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CONTRACTINGS
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:LEGENDRE
Authorized Official - Last Name:BOUDREAUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-493-4907
Mailing Address - Street 1:PO BOX 5478
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70302-5478
Mailing Address - Country:US
Mailing Address - Phone:985-369-6070
Mailing Address - Fax:985-369-3514
Practice Address - Street 1:114 HWY 403
Practice Address - Street 2:
Practice Address - City:PAINCOURTVILLE
Practice Address - State:LA
Practice Address - Zip Code:70391-0300
Practice Address - Country:US
Practice Address - Phone:985-369-6070
Practice Address - Fax:985-369-3514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-27
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LACN8396OtherRAILROAD MEDICARE
LA2368311Medicaid
LACN8396OtherRAILROAD MEDICARE