| Thibodaux Regional Network Development Corporation - Family Medicine | |
|
114 Hwy 403 Paincourtville LA 70391-0300 | |
| (985) 369-6070 | |
| (985) 369-3514 |
| Full Name | Thibodaux Regional Network Development Corporation - Family Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 114 Hwy 403, Paincourtville, Louisiana |
| Authorized Official Name and Position | Kim Legendre Boudreaux (DIRECTOR OF CONTRACTINGS) |
| Authorized Official Contact | 9854934907 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Thibodaux Regional Network Development Corporation - Family Medicine Po Box 5478 Thibodaux LA 70302-5478 Ph: (985) 369-6070 | Thibodaux Regional Network Development Corporation - Family Medicine 114 Hwy 403 Paincourtville LA 70391-0300 Ph: (985) 369-6070 |
| NPI Number | 1396162269 |
|---|---|
| Provider Enumeration Date | 03/27/2014 |
| Last Update Date | 09/06/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396162269 | NPI | - | NPPES |
| 2368311 | Medicaid | LA | |
| CN8396 | Other | LA | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |