| Thibodeaux Medical Clinic, Llc | |
|
1303 Horridge St Vinton LA 70668-4531 | |
| (337) 324-8060 | |
| (337) 324-8061 |
| Full Name | Thibodeaux Medical Clinic, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1303 Horridge St, Vinton, Louisiana |
| Authorized Official Name and Position | Derrick Thibodeaux (NURSE PRACTITIONER) |
| Authorized Official Contact | 3373248060 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Thibodeaux Medical Clinic, Llc 1303 Horridge St Vinton LA 70668-4531 Ph: (337) 324-8060 | Thibodeaux Medical Clinic, Llc 1303 Horridge St Vinton LA 70668-4531 Ph: (337) 324-8060 |
| NPI Number | 1689224321 |
|---|---|
| Provider Enumeration Date | 09/15/2019 |
| Last Update Date | 03/23/2020 |
| Medicare PECOS PAC ID | 2365774189 |
|---|---|
| Medicare Enrollment ID | O20191029000957 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689224321 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Derrick F Thibodeaux |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659762839 PECOS PAC ID: 4385946565 Enrollment ID: I20160105001532 |
| Provider Name | Bonnie Spellman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902689011 PECOS PAC ID: 7315301215 Enrollment ID: I20230911003974 |
Calcasieu Cameron Hospital Service District Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1611 Hampton St, Vinton, LA 70668 Phone: 337-589-5951 Fax: 337-589-4013 |