NPIMap

Organization Active NPI

Thibodaux Regional Network Development Corporation

Doing business as Thibodaux Regional Family Medicine Clinic - Paincourtville

  • Family Medicine Physician
  • Paincourtville, LA
National Provider Identifier
1396162269
Registry record updated Jun 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
THIBODAUX REGIONAL NETWORK DEVELOPMENT CORPORATION
Doing business as
Thibodaux Regional Family Medicine Clinic - Paincourtville
Practice address
114 Hwy 403
Paincourtville, LA 70391-0300
Phone
(985) 369-6070
Fax
(985) 369-3514
NPI assigned
Mar 27, 2014
Last updated
Jun 3, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2025

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

Authorized official

Name
Kim Legendre Boudreaux
Title
Director of Contractings
Phone
(985) 493-4907

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

114 Hwy 403
Paincourtville, LA 70391-0300

Mailing address

PO Box 5478
Thibodaux, LA 70302-5478
Phone (985) 369-6070

Other practice location 1

3928 Highway 70 S
Pierre Part, LA 70339-4460
Phone (985) 353-1111

Other identifiers 2

IdentifierTypeStateIssuer
2368311MedicaidLA
CN8396OtherLARAILROAD MEDICARE

Other names 1

  • Thibodaux Regional Family Medicine Clinic - Paincourtville 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
19D0459961Thibodaux Regional Family Medicine Clinic114 Hwy 403, Paincourtville, LA 70391Provider-performed microscopyAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Thibodaux Regional Network Development Corporation27 organizations share this tax ID, including this one

Other organizations with this tax ID 26

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

View all 26

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": "1395878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748908800000",
    "number": "1396162269",
    "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": "985-369-6070",
            "fax_number": "985-369-3514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 HWY 403",
            "city": "PAINCOURTVILLE",
            "state": "LA",
            "postal_code": "703910300",
            "telephone_number": "985-369-6070",
            "fax_number": "985-369-3514"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3928 Highway 70 S",
            "address_purpose": "LOCATION",
            "city": "Pierre Part",
            "state": "LA",
            "postal_code": "703394460",
            "country_code": "US",
            "telephone_number": "985-353-1111",
            "fax_number": "985-252-1400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "THIBODAUX REGIONAL NETWORK DEVELOPMENT CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-27",
        "last_updated": "2025-06-03",
        "certification_date": "2025-06-03",
        "status": "A",
        "authorized_official_last_name": "BOUDREAUX",
        "authorized_official_first_name": "KIM",
        "authorized_official_middle_name": "LEGENDRE",
        "authorized_official_title_or_position": "DIRECTOR OF CONTRACTINGS",
        "authorized_official_telephone_number": "985-493-4907"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2368311",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CN8396",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Thibodaux Regional Family Medicine Clinic - Paincourtville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Paincourtville, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 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.