NPIMap

Organization Active NPI

Life Coast Community Health Center Inc

  • Internal Medicine Physician
  • Thibodaux, LA
National Provider Identifier
1073157970
Registry record updated Sep 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
LIFE COAST COMMUNITY HEALTH CENTER INC
Practice address
504 N Acadia Rd
Thibodaux, LA 70301-4862
Phone
(985) 492-6170
NPI assigned
Nov 4, 2019
Last updated
Sep 18, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2025

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

Authorized official

Name
Diane Webre
Title
Clinic Manager
Phone
(985) 492-6170

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

504 N Acadia Rd
Thibodaux, LA 70301-4862

Mailing address

504 N Acadia Rd
Thibodaux, LA 70301-4862
Phone (985) 492-6170

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200205001617 LA Part B Supplier - Clinic/Group Practice 3870929193 Receives reassigned benefits from 21 practitioners
Practice locations: Thibodaux, LA; Houma, LA

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Life Coast Community Health6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

496 Corporate Dr
Houma, LA 70360
Phone (985) 262-1639

1101 Audubon Ave
Thibodaux, LA 70301
Phone (985) 447-7246

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Life Coast Community Health Center IncHouma, LA, CCN 191111 Federally qualified health center Other Dec 2, 2019
Life Coast Community Health Center IncThibodaux, LA, CCN 191110 Federally qualified health center Other Dec 2, 2019

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 25

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.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1572825600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758153600000",
    "number": "1073157970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 N ACADIA RD",
            "city": "THIBODAUX",
            "state": "LA",
            "postal_code": "703014862",
            "telephone_number": "985-492-6170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 N ACADIA RD",
            "city": "THIBODAUX",
            "state": "LA",
            "postal_code": "703014862",
            "telephone_number": "985-492-6170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE COAST COMMUNITY HEALTH CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-04",
        "last_updated": "2025-09-18",
        "certification_date": "2025-09-18",
        "status": "A",
        "authorized_official_last_name": "WEBRE",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "CLINIC MANAGER",
        "authorized_official_telephone_number": "985-492-6170"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Thibodaux, LA

Sources for this page

Verify at the official NPI Registry.