NPIMap

Organization Active NPI

Thibodaux Regional Network Development Corporation

Doing business as Thibodaux Regional Urology Clinic

  • Urology Physician
  • Thibodaux, LA
National Provider Identifier
1043834260
Registry record updated Jul 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
THIBODAUX REGIONAL NETWORK DEVELOPMENT CORPORATION
Doing business as
Thibodaux Regional Urology Clinic
Practice address
506 N Acadia Rd
Thibodaux, LA 70301-4862
Phone
(985) 493-4907
Fax
(985) 449-2585
NPI assigned
Jun 3, 2020
Last updated
Jul 9, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2025

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

Authorized official

Name
Kim Legendre Boudreaux
Title
Contract Management
Phone
(985) 493-4907

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208800000X Primary

Addresses

Primary practice location

506 N Acadia Rd
Thibodaux, LA 70301-4862

Mailing address

PO Box 5478
Thibodaux, LA 70302-5478
Phone (985) 438-4831

Other names 1

  • Thibodaux Regional Urology Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040608000132 LA Part B Supplier - Clinic/Group Practice 8224011754 Receives reassigned benefits from 181 practitioners
37 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Thibodaux, LA; Vacherie, LA; Houma, LA; Labadieville, LA; Paincourtville, LA; Pierre Part, LA; Raceland, LA

Other NPIs on the same Medicare enrollment 37

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 37

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
19D0459634Thibodaux Regional Urology Clinic506 North Acadia Rd, Thibodaux, LA 70301Provider-performed microscopyNov 14, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1591142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752019200000",
    "number": "1043834260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5478",
            "city": "THIBODAUX",
            "state": "LA",
            "postal_code": "703025478",
            "telephone_number": "985-438-4831",
            "fax_number": "985-449-2585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "506 N ACADIA RD",
            "city": "THIBODAUX",
            "state": "LA",
            "postal_code": "703014862",
            "telephone_number": "985-493-4907",
            "fax_number": "985-449-2585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THIBODAUX REGIONAL NETWORK DEVELOPMENT CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-03",
        "last_updated": "2025-07-09",
        "certification_date": "2025-07-09",
        "status": "A",
        "authorized_official_last_name": "BOUDREAUX",
        "authorized_official_first_name": "KIM",
        "authorized_official_middle_name": "LEGENDRE",
        "authorized_official_title_or_position": "CONTRACT MANAGEMENT",
        "authorized_official_telephone_number": "985-493-4907"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Thibodaux Regional Urology Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Thibodaux Regional Urology Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Thibodaux, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.