Thibodeaux Medical Clinic, Llc | |
1303 Horridge St Vinton LA 70668-4531 | |
(337) 324-8060 | |
(337) 324-8061 |
Full Name | Thibodeaux Medical Clinic, Llc |
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Speciality | Family Medicine |
Location | 1303 Horridge St, Vinton, Louisiana |
Authorized Official Name and Position | Derrick Thibodeaux (NURSE PRACTITIONER) |
Authorized Official Contact | 3373248060 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Thibodeaux Medical Clinic, Llc 1303 Horridge St Vinton LA 70668-4531 Ph: (337) 324-8060 | Thibodeaux Medical Clinic, Llc 1303 Horridge St Vinton LA 70668-4531 Ph: (337) 324-8060 |
NPI Number | 1689224321 |
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Provider Enumeration Date | 09/15/2019 |
Last Update Date | 03/23/2020 |
Medicare PECOS PAC ID | 2365774189 |
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Medicare Enrollment ID | O20191029000957 |
Identifier | Type | State | Issuer |
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1689224321 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Derrick F Thibodeaux |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1659762839 PECOS PAC ID: 4385946565 Enrollment ID: I20160105001532 |
Vinton Medical Clinic Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1611 Hampton St, Vinton, LA 70668 Phone: 337-589-5951 Fax: 337-589-4013 |