Teche Action Clinic @ Thibodaux | |
1709 Ridgefield Rd Thibodaux LA 70301-4333 | |
(337) 828-2550 | |
(337) 355-2335 |
Full Name | Teche Action Clinic @ Thibodaux |
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Speciality | Clinic/Center |
Location | 1709 Ridgefield Rd, Thibodaux, Louisiana |
Authorized Official Name and Position | Gary M Wiltz (CEO) |
Authorized Official Contact | 3378282550 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Teche Action Clinic @ Thibodaux 1115 Weber St Franklin LA 70538-4124 Ph: (337) 828-2550 | Teche Action Clinic @ Thibodaux 1709 Ridgefield Rd Thibodaux LA 70301-4333 Ph: (337) 828-2550 |
NPI Number | 1356767420 |
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Provider Enumeration Date | 03/12/2014 |
Last Update Date | 07/12/2023 |
Medicare PECOS PAC ID | 0648163980 |
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Medicare Enrollment ID | O20140923000681 |
Identifier | Type | State | Issuer |
---|---|---|---|
1356767420 | NPI | - | NPPES |
2381954 | Medicaid | LA | |
5B803 | Other | LA | MEDICARE PART B |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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