Provider Demographics
NPI:1801949631
Name:THIBODAUX SURGERY CENTER, LLC
Entity type:Organization
Organization Name:THIBODAUX SURGERY CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:LANDRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-446-1763
Mailing Address - Street 1:604 N ACADIA RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-4847
Mailing Address - Country:US
Mailing Address - Phone:985-449-1244
Mailing Address - Fax:985-449-1242
Practice Address - Street 1:604 N ACADIA RD
Practice Address - Street 2:SUITE 300
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4847
Practice Address - Country:US
Practice Address - Phone:985-449-1244
Practice Address - Fax:985-449-1242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA151261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5A878-6746Medicare ID - Type UnspecifiedGUY P. ZERINGUE, III
LAG46373Medicare ID - Type UnspecifiedMARK F. HEBERT
LA19-0004Medicare ID - Type UnspecifiedTRMC
LA5L870Medicare ID - Type UnspecifiedBARRY G. LANDRY
LA5L888Medicare ID - Type UnspecifiedRICHARD A. MORVANT,JR
LA5L163Medicare ID - Type UnspecifiedTHOMAS R. DONNER
LA5Y746Medicare ID - Type UnspecifiedPASAM S. RAO
LA5N958Medicare ID - Type UnspecifiedPATRICK C. HAGEN
LA53352Medicare ID - Type UnspecifiedNEIL J. MAKI
LA5K296Medicare ID - Type UnspecifiedSARAT K. DONEPUDI