Organization · Type 2 NPI

Thibodaux Regional Network Development Corporation

Multi-Specialty Clinic/Center · Raceland, LA

NPI number 1497348379 Active

Practice location

4560 Highway 1 Ste 3
Raceland, LA 70394-2779

Call (985) 435-4831 Map

Fax (985) 449-2513

Mailing address

602 N Acadia Rd
Thibodaux, LA 70301-4823

Specialties and licenses

Taxonomy	Code	License
Family Medicine Physician	207Q00000X	None listed
Internal Medicine Physician	207R00000X	None listed
Hematology (Internal Medicine) Physician	207RH0000X	None listed
Hematology & Oncology Physician	207RH0003X	None listed
Pulmonary Disease Physician	207RP1001X	None listed
Neurological Surgery Physician	207T00000X	None listed
Pediatrics Physician	208000000X	None listed
Neurology Physician	2084N0400X	None listed
Urology Physician	208800000X	None listed
Multi-Specialty Clinic/Center Primary	261QM1300X	None listed
Family Nurse Practitioner	363LF0000X	None listed

Multi-Specialty Clinic/Center: Definition to come...

NPI record

NPI: 1497348379
Entity type: Organization (Type 2)
Issued: Feb 11, 2021
Last updated: Sep 5, 2023
Status: Active

Other names

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Thibodaux Regional Multi-Specialty Clinic-Raceland · doing business as
Thibodaux Regional Multi-Specialty Clinic-Raceland · doing business as

Authorized official

Kim Legendre Boudreaux
Contract Manager
(985) 493-4907

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1497348379

Thibodaux Regional Network Development Corporation's National Provider Identifier is 1497348379, issued on Feb 11, 2021. The primary taxonomy on file is Multi-Specialty Clinic/Center (261QM1300X), and the practice location is in Raceland, LA. The record was last updated on Sep 5, 2023.