Provider Demographics
NPI:1831167329
Name:THIBODAUX ENDOSCOPY LLC
Entity type:Organization
Organization Name:THIBODAUX ENDOSCOPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:J
Authorized Official - Last Name:MONIER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:985-446-1958
Mailing Address - Street 1:764 N ACADIA RD STE B
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-5009
Mailing Address - Country:US
Mailing Address - Phone:985-446-1958
Mailing Address - Fax:985-446-0121
Practice Address - Street 1:764 N ACADIA RD STE B
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-5009
Practice Address - Country:US
Practice Address - Phone:985-446-1958
Practice Address - Fax:985-446-0121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0112261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1167452Medicaid
LA1167452Medicaid