KIDNEY CENTER OF SOUTH LOUISIANA, AMC (NPI# 1386858918) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386858918 |
| Entity Type | Organization |
| Organization Name | KIDNEY CENTER OF SOUTH LOUISIANA, AMC |
| Practice Address |
604 N. Acadia Rd. Suite 405 Thibodaux LA 70301 |
| Practice Telephone | 9854460871 |
| Practice Fax Number | 9854460874 |
| Mailing Telephone | 9854460871 |
| Mailing Fax Number | 9854460874 |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2018-09-12 |
| Authorized Official Name | MRS. VICKI C. LEDET (PRACTICE ADMINISTRATOR) |
| Authorized Official Telephone | 9854460871 |
| Is Organization Subpart | Y |
| Parent Organization Name | KIDNEY CENTER OF SOUTH LOUISIANA, AMC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RN0300X |
Internal Medicine Specialization: Nephrology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | RAILROAD MEDICARE | CH9035 | 01 |
| Street Address |
604 N. ACADIA RD. SUITE 405 |
| City | THIBODAUX |
| State | LA |
| Zip Code | 70301 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063413995 | James Kevin Modisette | Internal Medicine | 604 N. Acadia Rd., Suite 405, Thibodaux, LA 70301 | 2005-08-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225539620 | Micah Aaron Callais | Nurse Practitioner | 604 N. Acadia Road, Suite 200, Thibodaux, LA 70301 | 2018-02-22 |
| 1982112348 | Katie Leblanc | Massage Therapist | 1115 St. Mary Street, Thibodaux, LA 70301 | 2018-01-18 |
| 1154837391 | Texas Digestive Disease Consultants, Pllc | Internal Medicine | 764 North Acadia Road, Suite A, Thibodaux, LA 70301 | 2017-12-26 |
| 1235648239 | Speech and Feeding Therapy, LLC | Speech-Language Pathologist | 1000 Plantation Rd Ste 1a, Thibodaux, LA 70301 | 2017-09-22 |
| 1285150466 | Tara Payne | Counselor | 303 Hickory Street, Thibodaux, LA 70301 | 2017-08-18 |
| 1427583475 | Tyler Pettigrew | Counselor | 300 Plantation Rd., Apt #24, Thibodaux, LA 70301 | 2017-04-27 |
| 1750825758 | Jessica Barquet | Counselor | 110 Palm Villa Dr Apt 1, Thibodaux, LA 70301 | 2016-12-09 |
| 1013468230 | Shenee Haas Gros | Counselor | 504 Cherry St., Thibodaux, LA 70301 | 2016-10-24 |
| 1982155388 | Southern Ent Associates Inc | Audiologist | 604 North Acadia Road Suite 101, Thibodaux, LA 70301 | 2016-10-20 |
| 1215483888 | Lesheeca Norman, Lpc | Counselor | 306 Victoria Court, Thibodaux, LA 70301 | 2016-09-01 |
| Find all providers in zip 70301 | ||||
| Taxonomy Code | 207RN0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Nephrology |
| An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669473054 | Allen W. Vander | Internal Medicine | 604 N. Acadia Rd, Suite 405, Thibodaux, LA 70301 | 2005-08-09 |
| 1063413995 | James Kevin Modisette | Internal Medicine | 604 N. Acadia Rd., Suite 405, Thibodaux, LA 70301 | 2005-08-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114489929 | Cenla Kidney Specialists LLC | Internal Medicine | 6412 Genevieve Dr, Alexandria, LA 71301-2789 | 2019-04-01 |
| 1972060168 | Nni Covington LLC | Internal Medicine | 1970 N Highway 190 Ste A, Covington, LA 70433-5364 | 2019-02-25 |
| 1184178899 | Louisiana Cardiovascular and Nephrology Center of Excellence, LLC | Internal Medicine | 1418 Heather Dr, Opelousas, LA 70570-7716 | 2016-08-10 |
| 1356790596 | Moh'd Ahmed Sharshir | Internal Medicine | 1430 Tulane Ave, #8545, Tulane School of Medicine/nephrology and Hypertension D, New Orleans, LA 70112 | 2016-06-08 |
| 1619324456 | Syed Rizwan Ali Bokhari | Internal Medicine | 1430 Tulane Avenue, #8545, New Orleans, LA 70112 | 2016-05-23 |
| 1508259540 | Rana El Sabbagh | Internal Medicine | 2308 E Main St Ste E, New Iberia, LA 70560-4029 | 2015-03-16 |
| 1346667532 | Michael Charles Touchy II | Internal Medicine | 1542 Tulane Ave Ste 421, New Orleans, LA 70112-2865 | 2014-03-25 |
| 1346675188 | Srijan Tandukar | Internal Medicine | 2751 Albert L Bicknell Dr Ste 2b, Shreveport, LA 71103 | 2013-09-12 |
| 1366714669 | Medicine and Nephrology Clinic of New Orleans LLC | Internal Medicine | 5571 Read Blvd, New Orleans, LA 70127-3103 | 2012-02-01 |
| 1306115175 | Tony W. Leung, M.d. LLC | Internal Medicine | 105 Dr. Michael Debakey Drive, Lake Charles, LA 70606 | 2011-12-22 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.