Abundant Health Medical Clinic, LLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

Legal business name

ABUNDANT HEALTH MEDICAL CLINIC, LLC

Doing business as

Abundant Health Medical Clinic

Practice address

1001 Jackson St
Thibodaux, LA 70301-3227

Phone

(985) 492-9111

Fax

(985) 492-9114

NPI assigned

Oct 22, 2015

Last updated

Oct 22, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Adrienne Chanelle Robertson, M.D.

Title

Medical Director

Phone

(334) 294-2758

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Abundant Health Medical Clinic Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1445472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445472000000",
    "number": "1003288614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5011",
            "city": "THIBODAUX",
            "state": "LA",
            "postal_code": "703025011",
            "telephone_number": "985-492-9111",
            "fax_number": "985-492-9114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 JACKSON ST",
            "city": "THIBODAUX",
            "state": "LA",
            "postal_code": "703013227",
            "telephone_number": "985-492-9111",
            "fax_number": "985-492-9114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABUNDANT HEALTH MEDICAL CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-22",
        "last_updated": "2015-10-22",
        "status": "A",
        "authorized_official_last_name": "ROBERTSON",
        "authorized_official_first_name": "ADRIENNE",
        "authorized_official_middle_name": "CHANELLE",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "334-294-2758",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2371231.",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Abundant Health Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Medical Specialty Clinic/Center in Thibodaux, LA
• Providers in Thibodaux, LA by specialty
• Medical Specialty Clinic/Center in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.