Provider Demographics
NPI:1124270749
Name:THIBODAUX INTERNAL MEDICINE ASSOCIATES,INC.
Entity type:Organization
Organization Name:THIBODAUX INTERNAL MEDICINE ASSOCIATES,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEO
Authorized Official - Middle Name:P
Authorized Official - Last Name:HEBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-446-2131
Mailing Address - Street 1:142 RUE MARGUERITE
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-6738
Mailing Address - Country:US
Mailing Address - Phone:985-446-2131
Mailing Address - Fax:
Practice Address - Street 1:142 RUE MARGUERITE
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-6738
Practice Address - Country:US
Practice Address - Phone:985-446-2131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-14
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09201R305R00000X
207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No305R00000XManaged Care OrganizationsPreferred Provider OrganizationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAB8908OtherBLUE CROSS BLUE SHIELD