NPIMap

Organization Active NPI

Thibodaux Regional Network Development Corporation

Doing business as Thibodaux Regional Gastroenterology Clinic

  • Gastroenterology Physician
  • Thibodaux, LA
National Provider Identifier
1659124485
Registry record updated Jun 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
THIBODAUX REGIONAL NETWORK DEVELOPMENT CORPORATION
Doing business as
Thibodaux Regional Gastroenterology Clinic
Practice address
604 N Acadia Rd
Ste 410
Thibodaux, LA 70301-4897
Phone
(985) 493-4120
Fax
(985) 493-4121
NPI assigned
Apr 10, 2024
Last updated
Jun 2, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 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 Contracting
Phone
(985) 493-4907

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X NU Primary

Addresses

Primary practice location

604 N Acadia Rd
Ste 410
Thibodaux, LA 70301-4897

Mailing address

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

Other names 1

  • Thibodaux Regional Gastroenterology 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

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

Locations

1107 Audubon Ave
#A
Thibodaux, LA 70301
Phone (504) 446-9785

Practitioners & affiliated clinicians

Practitioners 3

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": "1712707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748822400000",
    "number": "1659124485",
    "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",
            "city": "THIBODAUX",
            "state": "LA",
            "postal_code": "703014897",
            "telephone_number": "985-493-4120",
            "fax_number": "985-493-4121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THIBODAUX REGIONAL NETWORK DEVELOPMENT CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-10",
        "last_updated": "2025-06-02",
        "certification_date": "2025-06-02",
        "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": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Thibodaux Regional Gastroenterology Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Thibodaux Regional Gastroenterology 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 Jun 2, 2025; 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.