MR. AMBROSE CARROLL THIBODEAUX JR.


Address: 1015 Choctaw Dr, Opelousas, LA 70570-6567
Phone: 3379346453

MR. AMBROSE CARROLL THIBODEAUX JR. (NPI# 1538342431) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1538342431
Entity Type Individual
Full Name MR. AMBROSE CARROLL THIBODEAUX JR.
Credential MT
Practice Address 1015 Choctaw Dr
Opelousas
LA 70570-6567
Practice Telephone 3379346453
Mailing Telephone 3379346453
Enumeration Date 2007-12-13
Last Update Date 2007-12-13
Gender Code M
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 246QM0706X Spec/Tech, Pathology
Specialization: Medical Technologist
CLP.G02111-GEN LA Technologists, Technicians & Other Technical Service Providers

Other Provider Identifier

State Issuer Identifier Type Code
MT BRD CLIN LAB SCIEN PRACT 1499 01
LA ST BRD MEDICAL EXAMINES CLP.G02111-GEN 01
NE BUR OF LIC & CERT. 19554TCL-0 01

Office Location

Street Address 1015 CHOCTAW DR
City OPELOUSAS
State LA
Zip Code 70570-6567

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1538704010 Southern Family Medicine, LLC Nurse Practitioner 10818 Hwy. 190, Opelousas, LA 70570 2019-11-08
1952952061 Check Point Urgent Care Clinic/Center 2331 S Union Street, Opelousas, LA 70570 2019-09-20
1639734015 Southern Pharmacy LLC Pharmacy 3939 I-49 South Service Rd., Opelousas, LA 70570 2019-05-01
1245708452 Anthony Ray Parker Jr. Case Manager/Care Coordinator 208 Ballard Loop, Opelousas, LA 70570 2018-11-06
1306329511 Katherine D Trahan Pharmacy 3935 I-49 South Service Rd, Opelousas, LA 70570 2018-09-13
1548752942 Justin Y Auzenne Driver 230 Lemelle St, Opelousas, LA 70570 2018-05-31
1063920650 Laykin Bellard Nurse Practitioner 3975 I-49 Frontage Rd, Suite 201, Opelousas, LA 70570 2018-01-17
1124535562 Lisa M Miller Counselor 1211 Austin Rd, Opelousas, LA 70570 2018-01-08
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Taxonomy Information

Taxonomy Code 246QM0706X
Grouping Technologists, Technicians & Other Technical Service Providers
Classification Spec/Tech, Pathology
Specialization Medical Technologist

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1477992691 Kim Tobin Spec/Tech, Pathology 11 Brent Ct, Baton Rouge, LA 70808-9060 2013-06-20
1972845329 Stephanie Ann Stevens Spec/Tech, Pathology 310 Marilyn Dr, Sulphur, LA 70663-4029 2013-03-25
1982863619 Laura Ourso Spec/Tech, Pathology 218 E Washington St, Shreveport, LA 71104-3544 2008-06-06
1629249347 Miriam J Wilbon Spec/Tech, Pathology 3330 Masonic Dr, Alexandria, LA 71301-3841 2008-03-20
1124224142 Essie B Mack Spec/Tech, Pathology 1567 S Range Ave, Denham Springs, LA 70726-5201 2007-06-26
1043288558 Scott O Sibley Spec/Tech, Pathology 1455 Wright Ave, Crowley, LA 70526-2220 2006-03-09

Competitor

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City OPELOUSAS
Zip Code 70570

Improve Information

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Dataset Information

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.

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