Thibodeaux Medical Clinic, LLC
Organization Active NPI Family Medicine Physician · Vinton, LA
NPI 1689224321 · NPPES record last updated Apr 21, 2026
Key facts
- NPI
- 1689224321
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- THIBODEAUX MEDICAL CLINIC, LLC
- Practice address
- 1303 Horridge St
Vinton, LA 70668-4531 - Phone
- (337) 324-8060
- Fax
- (337) 324-8061
- NPI assigned
- Sep 15, 2019
- Organization subpart
- No
Authorized official
- Name
- Mr. Derrick Thibodeaux, NP
- Title
- Nurse Practitioner
- Phone
- (337) 324-8060
Practitioners 6
-
Bonnie Spellman, FNP-C
-
Derrick Thibodeaux, N.P.
-
Madison Theriot Lestage, FNP-C
-
Lexus Louvier Martin, APRN, FNP-C
-
Micca R Riedel, ANP-C, GNP-BC
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 19D2175182 | Thibodeaux Medical Clinic, LLC | Certificate of waiver | Nov 17, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20191029000957 | LA | Part B Supplier - Clinic/Group Practice | 2365774189 |
Receives reassigned benefits from 4 practitioners Practice locations: Vinton, LA |
National Provider Directory
Locations
1303 Horridge St
Vinton, LA 70668
Phone (337) 324-8060
1311 Horridge St
Vinton, LA 70668
Phone (337) 324-8060
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
1303 Horridge St
Vinton, LA 70668-4531
Mailing address
1303 Horridge St
Vinton, LA 70668-4531
Phone (337) 324-8060
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | thibodeauxmedicalclinic@gmail.com |
Other providers in Vinton, LA
- St. Angela Merici Foundation
- St. Angela Merici Foundation
- St. Angela Merici Foundation
- St. Angela Merici Foundation
- Katherine Stephens
- Derrick Thibodeaux
- Lance Waldmeier
- Valarie Philliber Waldmeier
All providers in Vinton, LA · Family Medicine Physician in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 21, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.