NPIMap

Organization Active NPI

Thibodaux Regional Network Development Corporation

  • Nephrology Physician
  • Thibodaux, LA
National Provider Identifier
1487511150
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
THIBODAUX REGIONAL NETWORK DEVELOPMENT CORPORATION
Practice address
604 N Acadia Rd
Ste 410 - Nephrology
Thibodaux, LA 70301-4955
Phone
(985) 493-4087
Fax
(985) 493-4088
NPI assigned
Jan 6, 2026
Organization subpart
Yes
Parent organization
THIBODAUX REGIONAL NETWORK DEVELOPMENT CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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 Contracting
Phone
(985) 493-4907

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RN0300X Primary

Addresses

Primary practice location

604 N Acadia Rd
Ste 410 - Nephrology
Thibodaux, LA 70301-4955

Mailing address

602 N Acadia Rd
Thibodaux, LA 70301-4823
Phone (985) 493-4907

Other practice location 1

604 N Acadia Rd
Ste 405 - Nephrology
Thibodaux, LA 70301-4897
Phone (985) 493-4087

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

National Provider Directory

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

Other organizations with this tax ID 26

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

View all 26

Locations

105 Rezin Ct
Thibodaux, LA 70301
Phone (985) 493-4444

NPI Registry JSON

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

{
    "created_epoch": "1767657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1783900800000",
    "number": "1487511150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "602 N ACADIA RD",
            "city": "THIBODAUX",
            "state": "LA",
            "postal_code": "703014823",
            "telephone_number": "985-493-4907",
            "fax_number": "985-449-2585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "604 N ACADIA RD",
            "address_2": "STE 410 - NEPHROLOGY",
            "city": "THIBODAUX",
            "state": "LA",
            "postal_code": "703014955",
            "telephone_number": "985-493-4087",
            "fax_number": "985-493-4088"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "604 N Acadia Rd",
            "address_2": "STE 405 - NEPHROLOGY",
            "address_purpose": "LOCATION",
            "city": "Thibodaux",
            "state": "LA",
            "postal_code": "703014897",
            "country_code": "US",
            "telephone_number": "985-493-4087",
            "fax_number": "985-493-4088",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "THIBODAUX REGIONAL NETWORK DEVELOPMENT CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THIBODAUX REGIONAL NETWORK DEVELOPMENT CORPORATION",
        "enumeration_date": "2026-01-06",
        "last_updated": "2026-07-13",
        "certification_date": "2026-07-13",
        "status": "A",
        "authorized_official_last_name": "BOUDREAUX",
        "authorized_official_first_name": "KIM",
        "authorized_official_middle_name": "LEGENDRE",
        "authorized_official_title_or_position": "DIRECTOR OF CONTRACTING",
        "authorized_official_telephone_number": "985-493-4907"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.