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).
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 |
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 |
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 |
Street Address |
1015 CHOCTAW DR |
City | OPELOUSAS |
State | LA |
Zip Code | 70570-6567 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1821608282 | Dream Angels Agency | Home Health | 356 Country Ridge Rd., 21, Opelousas, LA 70570 | 2020-07-31 |
1588286389 | Kasey Dunn | Nurse Practitioner | 3983 Interstate-49 South Service Rd., Suite 103, Opelousas, LA 70570 | 2020-05-14 |
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 |
Find all providers in zip 70570 |
Taxonomy Code | 246QM0706X |
Grouping | Technologists, Technicians & Other Technical Service Providers |
Classification | Spec/Tech, Pathology |
Specialization | Medical Technologist |
Definition to come... |
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 |
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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.