| Thibodeaux Enterprises Of Texas | |
|
610 Strickland Dr Ste 130 Orange TX 77630-4788 | |
| (409) 330-4885 | |
| (409) 250-3020 |
| Full Name | Thibodeaux Enterprises Of Texas |
|---|---|
| Speciality | Clinic/Center |
| Location | 610 Strickland Dr Ste 130, Orange, Texas |
| Authorized Official Name and Position | Derrick Thibodeaux (OWNER) |
| Authorized Official Contact | 4093304885 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Thibodeaux Enterprises Of Texas 1303 Horridge St Vinton LA 70668-4531 Ph: (337) 324-8060 | Thibodeaux Enterprises Of Texas 610 Strickland Dr Ste 130 Orange TX 77630-4788 Ph: (409) 330-4885 |
| NPI Number | 1396455036 |
|---|---|
| Provider Enumeration Date | 12/05/2022 |
| Last Update Date | 12/28/2022 |
| Medicare PECOS PAC ID | 7416327309 |
|---|---|
| Medicare Enrollment ID | O20230111000506 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396455036 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Micca Riedel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538439385 PECOS PAC ID: 8224299557 Enrollment ID: I20120413000350 |
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