NPIMap

Organization Active NPI

Thibodaux Laser and Surgery Center, LLC

  • Certified Registered Nurse Anesthetist
  • Thibodaux, LA
National Provider Identifier
1275535148
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
THIBODAUX LASER AND SURGERY CENTER, LLC
Practice address
1101 Audubon Ave
Suite S4
Thibodaux, LA 70301-4957
Phone
(985) 447-5938
Fax
(985) 448-1521
NPI assigned
Aug 11, 2005
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Dr. Richard L Arceneaux, M.D.NPI 1396063996
Title
Manager
Phone
(985) 447-7246

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X LA Primary

Addresses

Primary practice location

1101 Audubon Ave
Suite S4
Thibodaux, LA 70301-4957

Mailing address

1101 Audubon Ave
Suite S4
Thibodaux, LA 70301-4957
Phone (985) 447-5938

Other identifiers 1

IdentifierTypeStateIssuer
CJ8872OtherRR MEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040517000339 LA Part B Supplier - Clinic/Group Practice 5991795486 Receives reassigned benefits from 11 practitioners
Practice locations: Thibodaux, LA

Other NPIs with the same Medicare PAC ID 1

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

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
19D0904433Thibodaux Laser & Surgery Center LLC1101 Audubon Avenue Suite S4, Thibodaux, LA 70301Certificate of waiverAug 17, 2027

National Provider Directory

National Provider Directory

Locations

1101 Audubon Ave
Ste S4
Thibodaux, LA 70301
Phone (985) 447-7246

Practitioners & affiliated clinicians

Practitioners 26

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 26

NPI Registry JSON

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

{
    "created_epoch": "1123718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1275535148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 AUDUBON AVE",
            "address_2": "SUITE S4",
            "city": "THIBODAUX",
            "state": "LA",
            "postal_code": "703014957",
            "telephone_number": "985-447-5938",
            "fax_number": "985-448-1521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 AUDUBON AVE",
            "address_2": "SUITE S4",
            "city": "THIBODAUX",
            "state": "LA",
            "postal_code": "703014957",
            "telephone_number": "985-447-5938",
            "fax_number": "985-448-1521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THIBODAUX LASER AND SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-11",
        "last_updated": "2022-07-21",
        "certification_date": "2020-09-08",
        "status": "A",
        "authorized_official_last_name": "ARCENEAUX",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "985-447-7246",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "LA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "CJ8872",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 21, 2022; 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.